WBC Path

Question 1

Marker on Hematopoietic Stem Cells

Answer 1

CD34

Question 2

Main two causative agents of Infectious Mononucleosis and a way to differentiate them.

Answer 2

EBV and CMV: monospot (+) means EBV

Question 3

Down syndrome patient presents with recurrent infection and slow healing bruises. TdT (+) and CD10, and CD19 markers are positive. What gene mutation has a poor prognosis?

Answer 3

Acute Lymphocytic Leukemia (B type)

t(9:22): Philadelphia chromosome

Question 4

Down syndrome patient presents with recurrent infection. Tests reveal positive myeloperoxidase stain and Auer rods are seen on blood smear. What is the gene mutation?

Answer 4

Acute Myeloid Leukemia

-t(15:17) involving retinoic acid receptor

Question 5

Patient presents with recurrent infection and eventually dies. Blood smear reveals lymphocytes and smudge cells. What is the most common cause of death?

Answer 5

Chronic Lymphocytic Leukemia

• naïve B cells
• leads to hypogammaglobulinemia and recurrent infection (most common cause of death)

Question 6

Patient presents with splenomegaly and “dry tap” bone marrow biopsy. Blood smear stain positive for tartrate-resistant acid phosphatase. What is the Dx?

Answer 6

Hair Cell Leukemia

• TRAP (+) staining
• bone marrow is fibrotic which is why there is no aspiration

Question 7

Patient presents with a nasty red rash that covers his upper torso. Skin ointments and topical steroids have no effect. Anti-fungals also don’t work. Blood smear shows a cerebriform nuclei in lymphocytes. List all the buzz words for this condition.

Answer 7

Mycosis Fungoides (sezary syndrome)

• neoplastic CD4 t cells
• sezary cells form in pautrier microabscesses

Question 8

Patient presents with large numbers of WBC in serum. Common gene mutations in this condition is t(9:22). What is the first line treatment?

Answer 8

Chronic Myeloid Leukemia

• driven by Philadelphia chromosome
• can progress to AML or ALL

Tx: imatinib (suppresses tyrosine kinase activity)

Question 9

Patient presents with itchy skin after a shower. What is the mutation and treatment?

Answer 9

Polycythemia vera
-JAK2 kinase mutation
-can also have blurry vision, or thrombosis
-most commonly proliferation of RBCs
Tx: phlebotomy

Question 10

Mutation in follicular lymphoma

Answer 10

t(14:18)
BCL-2 switches to Ig heavy chain
apoptosis inhibited

Question 11

Mutation in mantle cell lymphoma

Answer 11

t(11:14)
Cyclin D1 switches to Ig heavy chain
no inhibition of G1/S transition

Question 12

3 disease associations with marginal zone lymphoma

Answer 12

Hashimoto Thyroiditis
Sjogren Syndrome
H. pylori gastritis

Question 13

Mutation in Burkitt Lymphoma and its appearance on microscopy

Answer 13

t(8:14)
c-myc switching with Ig heavy chain
Starry Sky appearance
EBV infection

Question 14

Characteristic Cell of Hodgkin Lymphoma and its two markers

Answer 14

Reed Sternberg Cell

-CD15 and CD30

Question 15

What are B symptoms of HL?

Answer 15

Fever, chills, night sweats

Question 16

Most common type of HL

Answer 16

Nodular Sclerosis

bands of necrosis

Question 17

Best prognostic HL

Answer 17

Lymphocyte Rich

Question 18

HL associated with eosinophilia

Answer 18

Mixed Cellularity

Question 19

HL seen in HIV patients

Answer 19

Lymphocyte Depleted

Question 20

Patient presents with Roleuaux formation on blood smear.

Answer 20

Multiple Myeloma

Question 21

Systemic complication of multiple myeloma

Answer 21

Amyloidosis: from the production of lots of Ig heavy and light chains

Question 22

What are Bence Jones Proteins

Answer 22

Proteins of Ig light and heavy chains in the urine from multiple myeloma

Question 23

What is MGUS?

Answer 23

Monoclonal Gammopathy of Undetermined Significance

-basically a multiple myeloma without the bone lesions, bence jones proteinuria or hypercalcemia

Question 24

What is Waldenstrom Macroglobulinemia

Answer 24

Massive replication of IgM

-penatamers cause clogging and hyperviscosity syndrome leading to hemorrhage or even stroke