Miscellaneous II

Question 1

CD4:CD8 ratio

Answer 1

BM not good sample for this- rather PB is optimal

Question 2

Causes of dyserythropoiesis

Answer 2

NK/T cell neoplasm
LGL neoplasm
Aplastic anemia

Question 3

Hypocellular MDS

Answer 3

Should see increased blasts (otherwise, don’t flat out call it!)
Could be an evolving aplastic anemia

Question 4

Monoblasts by flow

Answer 4

Show decreased expression of CD14 and CD36 (also CD64)

Question 5

AML from MDS morphology

Answer 5

Often see a less packed marrow than de novo AML- still see background erythroid islands

Question 6

Burkitt lymphoma in HIV

Answer 6

Can look plasmacytoid

Question 7

Vacuoles in Burkitt

Answer 7

Fat- oil red O positive

Question 8

Vacuoles in Erythroleukemia

Answer 8

Glycogen- PAS positive

Question 9

c-MYC threshold IHC

Answer 9

50-70%

Question 10

Look for Parvovirus when you see…

Answer 10

Anemia and erythroid hypoplasia

Question 11

Percent dysplasia to call

Answer 11

at least 10%

Question 12

Hematogones in MDS

Answer 12

decreased

Question 13

MDS comment:

Answer 13

These findings (dyserythropoiesis) are non-specific, and may be seen in:

• nutritional deficiency
• meds
• infection
• autoimmune
• low grade MDS

Question 14

Percent hypersegmented PMNs to call

Answer 14

Greater or equal to 6%

Question 15

Granulocytic finding in Folate/B12 deficiency

Answer 15

giant band

Question 16

Assessing marrow cellularity

Answer 16

Better to do on a bad core than on a good clot section (clot section compresses fat and falsely increased cellularity)

Question 17

Left-shifted erythroids vs lymphoblasts

Answer 17

left-shifted erythroids= more cytoplasm

lymphoblasts= less cytoplasm

Question 18

MPN with lots of mature neutrophils, lacking myelocyte bulge

Answer 18

Consider PMF, atypical CML, and CNL

Question 19

Cat-scratch lymphadenitis

Answer 19

Stellate microabscess formation

if inguinal LN, cannot distinguish from lymphogranuloma venereum

Question 20

Plasma cell neoplasm oral cavity

Answer 20

ALWAYS remember to order HHV8 and EBER

Question 21

NLPHL architecture

Answer 21

If see PTGC but no effacement- Do NOT call NLPHL (without effacement)

Question 22

Marrow s/p rituxin

Answer 22

can see T cells in the marrow (see Foucar paper)

Question 23

Increased CD8 T cells

Answer 23

Can see in reactive conditions too (throws off CD4:CD8)

Question 24

Burkitt

Answer 24

• paucity of small lymphs
• “jigsaw” appearance
• DDx: ALL, blastic mantle cell, myeloid sarc

Question 25

Lymph node with histiocytes and/or granulomas

Answer 25

Aside from the usual AFB/GMS, consider also doing a PAS to look for Whipple’s disease (PAS+)

Question 26

Amyloidoma

Answer 26

AKA nodular amyloid:

• asymptomatic elderly with nodule on chest xray w/o evidence of systemic disease
• good prognosis, dont often progress to lymphoproliferative disorders
• well circumscribed amyloid, often with T lymphocytes and plasma cells
• granulomatous reaction to amyloid common, often calcification and ossification

Question 27

Nodular LP HL

Answer 27

LP cells are positive for BCL6, EMA, OCT2, BOB1; negative for CD15 and CD30 (BUT you can see CD30 positive large cells that are reactive immunoblasts unrelated to LP cells

Question 28

Percent IHC positivity for Hans algorithm

Answer 28

30%

Question 29

“Tumor Stage MF”

Answer 29

Even in the presence of an atypical T cell proliferation with loss of CD7 and CD5, you cannot call MF. This could still be REACTIVE! Need hx of MF to call MF/lymphoma.

Question 30

IHC for MCL

Answer 30

Should do both cyclin d1 and sox-11 because sox11 can also be positive in burkitt, lymphoblastic lymphoma, and blastoid variant of mcl (dont use it to distinguish these)

Question 31

Bcl2

Answer 31

Expressed in all low grade cell lymphomas- careful with nodular pattern of mcl

Question 32

FL by flow

Answer 32

Dim CD19

Question 33

FL marrow involvement

Answer 33

Almost always see by morphology. Due to paratrabecular location, the aspirate for flow may miss it, but usually the core will show.

Question 34

Buffy coat M:E

Answer 34

Can be falsely increased bc erythroids cluster together

Question 35

Disrupted cells on aspirate

Answer 35

Tend to be erythroid. Thats way you actually over estimate the M:E a little on aspirate vs core

Question 36

Weird FL

Answer 36

If FL starts expressing T cell markers like CD5, it must have either CD10 or t(14;18) to call it. Otherwise think about mantle cell or marginal zone. Also CD11c very rare in FL, more common in MZL

Question 37

Atypical CLL

Answer 37

???

Question 38

Iron stain helps you

Answer 38

Can tell erythroid precursors vs plasma cells; also helps you tell the M:E ratio better

Question 39

Very dysplastic looking mature PMNs (abnormal lobation, hypogranularity- really ugly), increased blasts and left shift on marrow

Answer 39

Can be due to GCSF- do not call high grade MDS

Question 40

Monocyte/macrophage/histiocyte associated markers

Answer 40

Lysozyme, CD14, CD68

Question 41

Hb H inclusions

Answer 41

• seen 3 gene deletion alpha (Hb H) and may be positive in 2 gene deletion (alpha thal minor)
• whole blood with brilliant cresyl blue causes oxidation and ppt of Hb h
• golf ball pattern