MCQ: Hematopathology – 40 MCQs | Kenya MBChB

40 Year 3: Hematopathology exam questions on MCQ: Hematopathology for medical students. Includes MCQs, answers, explanations and written questions. Sample: What

This MCQ set contains 40 questions on MCQ: Hematopathology in the Year 3: Hematopathology unit. Each question includes the correct answer and a detailed explanation for active recall and exam preparation.

Q1: What is the incidence of Non-Hodgkin Lymphoma per 100,000 population?

  1. A. 7
  2. B. 12
  3. C. 17
  4. D. 25

Correct answer: C – 17

NHL has an incidence of approximately 17/100,000, making it the 5th most common malignancy in developed countries. Its incidence has markedly increased over the last 50 years.

Q2: Which of the following best describes the spread pattern of Non-Hodgkin Lymphoma compared to Hodgkin Lymphoma?

  1. A. Orderly, contiguous spread
  2. B. Irregular, non-contiguous spread
  3. C. Always begins in mediastinal nodes
  4. D. Rarely involves extranodal sites

Correct answer: B – Irregular, non-contiguous spread

NHL spreads irregularly and unpredictably, with significant extranodal involvement. In contrast, HL spreads in an orderly, contiguous fashion from one nodal group to adjacent ones.

Q3: Which classification system is the current gold standard for lymphoma classification?

  1. A. Rappaport (1966)
  2. B. Kiel classification
  3. C. Working Formulation (1979)
  4. D. WHO/REAL classification

Correct answer: D – WHO/REAL classification

The REAL/WHO classification (1994/2001/2008) is the current gold standard. It combines morphology, immunophenotype, genetics, and clinical features. Earlier systems used morphology only or grade only.

Q4: In lymphoid neoplasms, what molecular event precedes malignant transformation?

  1. A. Loss of CD20 expression
  2. B. Antigen receptor gene rearrangement
  3. C. BCL-2 translocation
  4. D. MYC amplification

Correct answer: B – Antigen receptor gene rearrangement

In all lymphoid neoplasms, antigen receptor gene rearrangement precedes transformation. This means all daughter cells synthesize identical antigen receptor proteins — this is the molecular basis of clonality in lymphoma.

Q5: A MALT lymphoma does NOT respond to antibiotic therapy for H. pylori. Which translocation explains this?

  1. A. t(14;18)
  2. B. t(8;14)
  3. C. t(11;18) or t(1;14)
  4. D. t(2;5)

Correct answer: C – t(11;18) or t(1;14)

MALT lymphomas with t(11;18) or t(1;14) activate the NFκB pathway independently of H. pylori stimulation. These tumours do not regress with antibiotics and require chemotherapy.

Q6: Which lymphoma is associated with MALT of the skin specifically?

  1. A. H. pylori
  2. B. Borrelia species
  3. C. Chlamydia psittaci
  4. D. Campylobacter jejuni

Correct answer: B – Borrelia species

Different sites of MALT lymphoma have different infectious triggers: skin → Borrelia spp; eyes → Chlamydia psittaci; intestines → Campylobacter jejuni; stomach → H. pylori.

Q7: A 14-year-old male presents with a large mediastinal mass, night sweats and mild bone marrow involvement. Immunophenotyping shows CD1+, CD2+, CD5+, CD7+, TdT+. What is the diagnosis?

  1. A. Nodular sclerosis Hodgkin lymphoma
  2. B. Precursor T-cell lymphoblastic lymphoma
  3. C. Anaplastic large cell lymphoma
  4. D. Peripheral T-cell lymphoma

Correct answer: B – Precursor T-cell lymphoblastic lymphoma

Adolescent male + thymic/mediastinal mass + TdT+ + T-cell markers = Precursor T-cell ALL/LBL. This is aggressive but 90% achieve complete remission with aggressive chemo + CNS prophylaxis.

Q8: Which translocation carries the worst prognosis in Precursor B-cell ALL?

  1. A. t(12;21)
  2. B. t(4;11)
  3. C. t(9;22) — Philadelphia chromosome
  4. D. t(14;18)

Correct answer: C – t(9;22) — Philadelphia chromosome

The Philadelphia chromosome t(9;22) is the worst prognostic cytogenetic finding in ALL. t(12;21) carries the best prognosis. t(4;11) is associated with poor prognosis in infants.

Q9: What are "proliferation centres" in CLL/SLL histology?

  1. A. Areas of Reed-Sternberg cell clustering
  2. B. Loose aggregates of mitotically active prolymphocytes
  3. C. Germinal centres with centroblasts
  4. D. Areas of follicular hyperplasia

Correct answer: B – Loose aggregates of mitotically active prolymphocytes

Proliferation centres (pseudofollicles) are pathognomonic of CLL/SLL. They are loose aggregates of larger prolymphocytes that are mitotically active, scattered within the diffusely effaced lymph node architecture.

Q10: A patient with CLL has Hb 9g/dL and platelets 80×10⁹/L. What Binet and Rai stage is this?

  1. A. Binet A, Rai 0
  2. B. Binet B, Rai II
  3. C. Binet C, Rai IV
  4. D. Binet C, Rai III

Correct answer: C – Binet C, Rai IV

Binet C = Hb <10g/dL OR platelets <100×10⁹. Rai IV = lymphocytosis + thrombocytopenia. Both indicate advanced disease requiring treatment. Rai III = anaemia; Rai IV = thrombocytopenia.

Q11: What combination achieves complete remission in 69% of CLL patients?

  1. A. Chlorambucil + prednisolone
  2. B. CVP alone
  3. C. Rituximab + Fludarabine + Cyclophosphamide
  4. D. Alemtuzumab + CHOP

Correct answer: C – Rituximab + Fludarabine + Cyclophosphamide

RFC achieves complete remission in 69% of CLL cases. Fludarabine-containing regimens are preferred over CVP or CHOP. Alemtuzumab (anti-CD25) is more immunocompromising.

Q12: A 62-year-old woman has widespread painless lymphadenopathy for 3 years. Biopsy shows centrocytes and centroblasts in a nodular pattern. BCL-2+, CD10+. She is asymptomatic. What is the management?

  1. A. Immediate R-CHOP
  2. B. Watch and wait
  3. C. Allogeneic SCT immediately
  4. D. Radiotherapy to all nodes

Correct answer: B – Watch and wait

Stage II–IV asymptomatic follicular lymphoma = watch and wait. Treatment begins only when symptoms or complications develop. Up to 25% of cases also undergo spontaneous regression.

Q13: Histologic transformation in follicular lymphoma occurs at what rate per year and to what subtype?

  1. A. 1% per year to Burkitt lymphoma
  2. B. 3% per year to DLBCL
  3. C. 5% per year to mantle cell lymphoma
  4. D. 10% per year to Hodgkin lymphoma

Correct answer: B – 3% per year to DLBCL

Follicular lymphoma transforms to aggressive diffuse large B-cell lymphoma at approximately 3% per year. Overall transformation rate over the disease course is 30–50%. Grade IIIb is already treated as DLBCL.

Q14: Which prognostic scoring system is used specifically for follicular lymphoma?

  1. A. IPI
  2. B. NCCN-IPI
  3. C. FLIPI
  4. D. Binet system

Correct answer: C – FLIPI

FLIPI uses: age 60, Stage III–IV, Hb 4 nodal areas, and high LDH. IPI and NCCN-IPI are used for high-grade lymphomas like DLBCL.

Q15: What unique gastrointestinal manifestation can occur in Mantle Cell Lymphoma?

  1. A. Gastric ulceration
  2. B. Lymphomatoid polyposis of small bowel and colon
  3. C. Oesophageal varices
  4. D. Ischaemic colitis

Correct answer: B – Lymphomatoid polyposis of small bowel and colon

MCL can involve the GI tract producing lymphomatoid polyposis — multiple polyp-like lesions throughout the bowel. This is a characteristic but underappreciated feature of MCL. ~70% present at Stage IV.

Q16: What is seen on trephine biopsy in Mantle Cell Lymphoma?

  1. A. Paratrabecular infiltration only
  2. B. Small-medium cells with variable nuclear shapes and increased reticulin; intrasinusoidal infiltration prominent
  3. C. Reed-Sternberg cells with eosinophilic background
  4. D. Diffuse effacement with centroblasts only

Correct answer: B – Small-medium cells with variable nuclear shapes and increased reticulin; intrasinusoidal infiltration prominent

MCL trephine biopsy characteristically shows intrasinusoidal infiltration — a pattern also seen in splenic marginal zone lymphoma. Assessment of CD20 is important as Rituximab is used.

Q17: Which DLBCL subtype presents with superior vena cava syndrome?

  1. A. Plasmablastic DLBCL
  2. B. T-cell/histiocyte-rich DLBCL
  3. C. Primary mediastinal (Mediastinal) DLBCL
  4. D. Primary effusion DLBCL

Correct answer: C – Primary mediastinal (Mediastinal) DLBCL

Mediastinal DLBCL presents with a large anterior mediastinal mass causing SVC syndrome (facial oedema, arm swelling, JVP elevation). It predominantly affects young women and has distinct biology.

Q18: Which DLBCL subtype is specifically associated with HIV and body cavity effusions?

  1. A. Intravascular DLBCL
  2. B. Plasmablastic DLBCL
  3. C. Primary effusion DLBCL
  4. D. ALK-positive DLBCL

Correct answer: C – Primary effusion DLBCL

Primary effusion lymphoma is HIV-related, associated with HHV-8, and presents as malignant effusions in body cavities (pleural, peritoneal, pericardial) without a solid tumour mass.

Q19: A patient with Burkitt lymphoma has peripheral blood film showing large lymphoblasts with basophilic cytoplasm containing vacuoles. Which immunophenotype is expected?

  1. A. CD19+, CD10+, BCL2+, BCL6+
  2. B. CD19+, CD10+, BCL2−, BCL6+, SIgM+
  3. C. CD5+, CD23+, BCL2+, TdT+
  4. D. CD30+, ALK+, CD20−

Correct answer: B – CD19+, CD10+, BCL2−, BCL6+, SIgM+

Burkitt lymphoma is BCL2− — this is crucial to distinguish it from follicular lymphoma (BCL2+). Both are CD10+. The BCL2 negativity is due to MYC translocation driving rapid proliferation without BCL2 anti-apoptotic support.

Q20: What is the hallmark histological finding in Burkitt lymphoma and what does it represent?

  1. A. Pautrier microabscesses — T-cell clustering in epidermis
  2. B. Proliferation centres — aggregates of prolymphocytes
  3. C. Starry sky pattern — tingible-body macrophages engulfing apoptotic tumour cells
  4. D. Lacunar cells — RS cells in fibrotic background

Correct answer: C – Starry sky pattern — tingible-body macrophages engulfing apoptotic tumour cells

The starry sky appearance results from numerous pale macrophages (stars) scattered against a dark background of densely packed tumour cells (sky). The macrophages are engulfing apoptotic cells from the extremely high turnover rate ( 95% mitotic index).

Q21: Thomas Hodgkin first described Hodgkin Lymphoma in which year?

  1. A. 1798
  2. B. 1832
  3. C. 1860
  4. D. 1901

Correct answer: B – 1832

Thomas Hodgkin first described Hodgkin Lymphoma in 1832. It remains distinct from NHL in biology, morphology, immunophenotype, clinical features, and treatment.

Q22: What is the age distribution pattern of Hodgkin Lymphoma?

  1. A. Unimodal peak at 15–34 years
  2. B. Unimodal peak at 55 years
  3. C. Bimodal: 15–34 years and 55 years
  4. D. Predominantly children <10 years

Correct answer: C – Bimodal: 15–34 years and 55 years

HL has a characteristic bimodal age distribution. The first peak (15–34 years) is mainly Nodular Sclerosis type. The second peak ( 55 years) is mainly Mixed Cellularity and Lymphocyte Depleted types.

Q23: How does EBV contribute to the pathogenesis of Hodgkin Lymphoma?

  1. A. Direct insertion into BCL-2 gene causing overexpression
  2. B. LMP-1 upregulates NFκB → lymphocyte activation and RS cell survival
  3. C. EBV causes MYC translocation
  4. D. EBV directly transforms B cells into RS cells via CD20

Correct answer: B – LMP-1 upregulates NFκB → lymphocyte activation and RS cell survival

EBV's latent membrane protein-1 (LMP-1) transmits signals that upregulate NFκB, a transcription factor involved in lymphocyte activation and cell survival. RS cells also secrete cytokines (IL-5, IL-6, IL-13, TNF, GM-CSF) that recruit reactive cells supporting tumour growth.

Q24: What is the diagnostic Reed-Sternberg cell?

  1. A. Small cell with irregular nucleus and scant cytoplasm
  2. B. Large cell (15–45μm) with multiple nuclei or multilobed single nucleus, each with large inclusion-like nucleolus
  3. C. Cell with cerebriform nuclear chromatin and CD4+ phenotype
  4. D. Cell with horseshoe-shaped nucleus and voluminous cytoplasm

Correct answer: B – Large cell (15–45μm) with multiple nuclei or multilobed single nucleus, each with large inclusion-like nucleolus

The RS cell must be present in an appropriate background of non-neoplastic inflammatory cells (lymphocytes, plasma cells, eosinophils). RS cells alone are insufficient for diagnosis — context is essential.

Q25: Which RS cell variant is pathognomonic of Nodular Sclerosis Hodgkin Lymphoma?

  1. A. Mononuclear (Hodgkin cell)
  2. B. L&H (Popcorn) cell
  3. C. Lacunar cell
  4. D. Diagnostic RS cell

Correct answer: C – Lacunar cell

Lacunar cells have delicate, folded/multilobate nuclei surrounded by abundant pale cytoplasm. During histological sectioning, the cytoplasm retracts, leaving the nucleus sitting in an artificial empty space (lacuna). Pathognomonic of Nodular Sclerosis HL.

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