FRCPath Part1 Course
Lymphoreticular Pathology Granulomatous Lymphadenitis EMQ 1 For each of the following scenarios, select the most likely condition from the list of options.
1. A 35 year old woman develops enlarged left axillary lymph nodes. Excision biopsy shows serpiginous necrosis containing nuclear debris and surrounded by palisaded histiocytes. A WarthinStarry stain is positive. 2. A 24 year old woman presents with cervical lymphadenopathy. Lymph node histology shows follicular hyperplasia, monocytoid B-cell hyperplasia and small aggregates of epithelioid cells, some of which encroach on germinal centres. 3. A 55-year old man presented with weight loss, fever and polyarthralgia. An abdominal CT scan showed mesenteric and retroperitoneal lymphadenopathy. A laparoscopic lymph node biopsy shows collections PASD-positive mononuclear and multinucleated histiocytes with foamy cytoplasm. 4. A 30-year old woman presents with shortness of breath, a dry cough, weight loss and cervical lymphadenopathy. An excisional lymph node biopsy shows discrete nonnecrotising granulomas with focal fibrosis. 5. A 75-year old diabetic smoker presents with cough, fever and loss of weight. Lymph node biopsy shows granulomas with areas of central necrosis. Staining with PASD and Grocott is positive.
Reactive and Neoplastic Lymph Node Histology MCQ 2 A 20-year old Asian woman presents with painful enlarged lymph nodes in the neck, fever and flulike symptoms. Lymph node biopsy shows widespread apoptosis and necrosis with paracortical expansion by blast cells and histiocytes with crescentic nuclei. What is the most likely diagnosis? A. B. C. D. E.
Kikuchi’s disease Diffuse large B-cell lymphoma Kimura’s disease Cat scratch disease Infectious mononucleosis
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FRCPath Part1 Course MCQ 3 A 27-year old man is noted to have mediastinal widening on an occupational chest x-ray. Neck palpation reveals occasional enlarged lymph nodes, biopsy of which reveals sclerotic interfollicular bands with vascularised follicles surrounded by broad concentric mantle zones. What is the most likely diagnosis? A. B. C. D. E.
Nodular sclerosis Hodgkin’s lymphoma Kimura’s disease Nodular lymphocyte predominant Castleman’s disease Mantle cell lymphoma
Hodgkin’s lymphoma
EMQ 4
Match the following description with the appropriate disorder: 1. A 4-year old boy presents with a fever, cough and a red blotchy skin rash. A lymph node biopsy shows characteristic giant cells with multiple clustered and overlapping nuclei. 2. A 14-year old male presents with fever, night sweats and cervical lymphadenopathy. Lymph node biopsy shows sinus expansion by histiocytes, some of which contain engulfed lymphocytes. 3. A 33-year old man presents with enlarged cervical and axillary lymph nodes. Lymph node biopsy shows a nodular growth pattern with large cells containing multilobated nuclei that stain with CD20 but not CD15 or CD30. 4. A 30-year old man presented with episodes of pruritis, flushing and syncopal attacks. Maculopapular skin lesions were noted, which showed wealing on rubbing. Biopsy of an enlarged lymph node showed an infiltrate of cells with indented nuclei and abundant clear cytoplasm with granules that stain positively with toluidine blue. 5. A 2-year old boy presents with widespread scaling erythematous plaques on the skin, hepatosplenomegaly and lymphadenopathy. Lymph node biopsy shows distention of the sinuses by cells with grooved nuclei and abundant pale eosinophilic cytoplasm which stain positively with S100 and CD1a.
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FRCPath Part1 Course
Lymphoma Histology MCQ 5 A 25–year old man presents with firm, non-tender cervical lymphadenopathy. Lymph node biopsy shows a nodular growth pattern of small lymphocytes with very scanty eosinophils and neutrophils. Collagen bands are not evident. Scattered large mono- and binucleate cells are present (CD15+ and CD30+). What is the most likely diagnosis? A. B. C. D. E.
Nodular sclerosis Hodgkin’s lymphoma Nodular lymphocyte predominant Hodgkin’s lymphoma Lymphocyte rich Hodgkin’s lymphoma Lymphocyte depleted Hodgkin’s lymphoma Mixed cellularity Hodgkin’s lymphoma
MCQ 6 A 62-year old man presents with fever, night sweats, weight loss and lymphadenopathy. Lymph node biopsy shows complete effacement of the nodal architecture by large cells with prominent nucleoli that stain positively with CD20, CD79a, Bcl-2, Bcl-6 and are negative for CD30 and TdT. What is the most likely diagnosis? A. B. C. D. E.
Burkitt’s lymphoma Diffuse large B-cell lymphoma Anaplastic large cell lymphoma Lymphocyte-depleted Hodgkin’s lymphoma Lymphoblastic lymphoma
Lymphoma Genetics EMQ 7
Match the following chromosomal abnormalities with the appropriate disorder:
t2:5 t8:14 t11:14 t9:22 t14:18
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FRCPath Part1 Course
Extranodal Lymphoma MCQ 8 A 65-year old woman has a 7-month history of nausea, epigastric discomfort and weight loss. Gastric biopsy shows a monomorphic lymphocytic infiltrate in the lamina propria with infiltration of gastric glands by atypical lymphocytes. Curvilinear bacterial rods are present in the surface mucous. What is the most likely condition? A. B. C. D. E.
Mantle cell lymphoma Follicular lymphoma MALT lymphoma Chronic lymphocytic lymphoma Lymphoplasmacytic lymphoma
MCQ 9 A 60-year old woman presents with generalised painless lymphadenopathy. A previous diagnostic lymph node biopsy was performed. Now a bone marrow trephine biopsy shows nodular paratrabecular infiltrates of small lymphoid cells. What is the most likely diagnosis? A. B. C. D. E.
Chronic lymphocytic lymphoma Mantle cell lymphoma Follicular lymphoma Hairy cell leukaemia Lymphoplasmacytic lymphoma
MCQ 10 A 40–year old man presents with an acute abdomen and an emergency laparotomy is performed during which a segment of ulcerated and perforated jejunum is excised. The bowel wall is diffusely infiltrated by intermediate to large cells with irregular nuclei and prominent nucleoli. Post-operative serology reveals a raised IgA tissue transglutaminase antibody. What is the most likely diagnosis? A. Diffuse large B-cell lymphoma B. Anaplastic large cell lymphoma C. Enteropathy-associated T-cell lymphoma D. Mixed cellularity Hodgkin’s lymphoma
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