Non-neoplastic hematopathology_hemepath boards
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What benign condition can show aberrant expression of CD34 in megas?
Characteristic PB, BM and clinical findings in megaloblastic anemia?
Sieve-like nucleus, pancytopenia, marked anisopoikilocytosis (from spleen chomping up RBCs)
Characteristic findings in spleen with ITP?
- 1. Secondary follicles with well developed GCs in white pulp (follicles diminished w/steroid tx)
- 2. Dilated sinuses
- 3. GC contain CD41 and show macrophage phagocytosis of nuclear debris
- 4. Mild myeloid metaplasia or extramedullary hematopoiesis (megas mainly)
- 5. Histiocytes and neutrophils in red pulp
Name causes of extramedullary hematopoiesis.
- 1) MPD: Idiopathic Myelofibrosis, polycythemia vera, CML
- 2) Carcinoma with mets to bone
- 3) MDS
- 4) Hepatitis
- 5) Hemolytic anemia
myeloblasts and will also highlight proerythroblasts, mast cells, and occasionally promyelocytes.
IgG4 disease findings
- 1) LPC infiltrate with lots T cells
- 2) fibrosis
- 3) phlebitis
- 4) elevated serum IgG4
- 5) esp middle aged+ and males
- 6) can present as masses or nodules in lung
In HIV, what bone marrow features are prominent?
- 1) Chronic thrombocytopenia (impaired production and immune-mediated peripheral destruction)
- 2) small hypolobated or denuded megakaryocytes with pyknotic/smudgy nuclei
- 3) megakaryocytic hyperplasia and dysplasia
What is the theorized selective advantage in PNH?
Clonal abnormalities of GPI-linked surface proteins confer increased resistance to NK cell mediated apoptosis, increasing survival in an adverse enviroment of an aplastic BM
Identify the image. What conditions cause this?
Cabot ring - microtubules, remnants from mitotic spindle; pernicious anemia, erythroid production disorder, Pb poisoning
All of the following are major extrinsic causes of neutropenia except:
D) Autoimmune disorders
E) T-LGL leukemia
What is the differential diagnosis for a non-neoplastic sinus pattern in a LN?
Rosai Dorfman vs. lymphangiogram effect vs. nonspecific/reactive vs. Whipple disease hemophagocytic syndrome vs. dermatopathic lymphadenitis
What is the differential diagnosis for a non-neoplastic follicular pattern in a LN?
Viral (HIV) vs. Toxoplasmosis vs. syphilis vs. Castleman disease vs. rheumatoid arthritis or Sjogren syndrome vs. nonspecific
What is the differential diagnosis for a non-neoplastic inrterfollicular/paracortical pattern in a LN?
Viral (mono, CMV, postvaccine) vs. hypersensitivity (dilantin) vs. Kimura disease (eosinophilia with florid follicular hyperplasia and immunoblasts)
What is the differential diagnosis for a non-neoplastic granulomatous pattern in a LN?
- -Suppurative granulomata (cat-scratch, lymphogranulomatous venereum, tularemia)
- *LGV looks like cat-scratch in an inguinal node
- -Necrotizing (TB, Histoplasmosis, C. immitus, M. scrofulaceum)
- -Kikuchi (karyorrhexis with histiocytes and absent neutrophils)
What is the differential diagnosis for a non-neoplastic diffuse pattern in a LN?
Mainly viral (EBV, CMV, measles, post vaccine)
If a person presents with thrombocytopenia, left-shifted neutrophils without toxic granulation, hemoconcentration, and >10% immunoblast, what virus should you be worried about?
What does the presence of osteoblasts/osteoclasts in an adult BM indicate?
Bone destruction/repair (usually pathologic)
What are the clinical findings in hemophagocytic syndrome?
- 1) Hepatosplenomegaly
- 2) Markedly increased ferritin (>500 microg/L), CRP, ESR
- 3) Pancytopenia
- 4) Hemophagocytosis
- 5) Low fibrinogen
- 6) Elevated LFTs
- 7) Fever
Typical causes of hemophagocytic syndrome?
EBV, T-cell lymphoma, autoimmune
BM biopsy. What is the likely infection here?
Q fever (ring granuloma)
Pappenheimer bodies - blue/purple in color, in periphery, and not perfectly round; smaller than Howell-Jolly bodies; expelled iron-containing mitochondria
All of the following can show extensive replacement of BM by fibrous/spindled processes except:
A) Hodgkin lymphoma
C) Hairy cell leukemia
D) AML M4
D - only AML M7 (megakaryoblastic)
What are potential causes of serous fat atrophy (gelatinous transformation)?
- Mnemonic: MaDAM anorexic
- Malnutrition - anorexia
- Advanced malignancy
What is the average MPV for a platelet? What is the relationship between platelet volume (MPV) and platelet count? When does MPV go down? Up?
Between 2fL and 20fL; inverse relationship; down with thrombocytopenia or impaired production (AA); up with destruction, ITP, MPN, Bernard Soulier, etc. (basically getting bigger immature plts pushed out)
a 36 year old female presented with fever and flank pain. She was found to be pancytopenic with a WBC of 1.7, K/mm3. Absolute neutrophil count of 1.1, H/H 11.6/33.3, and plts 124 K/mm3. Diagnosis?
Parvovirus (picture shows giant proerythroblasts with nuclear inclusions)
A two-month old girl presented with cough and SOB. CBC showed leukocytosis with marked lymphocytosis. PB smear below. Dx?
Pertussis -Numerous mature lymphs with clefted nuclei
Likely PB smear findings?
(Megaloblastic anemia with sieve-like chromatin) - macrocytic anemia with hypersegmented neutrophils
Nieman Pick - vacuolated cells
Gaucher's disease - tissue paper looking
What is the defect in Autoimmune lymphoproliferative syndrome (ALPS)? Flow cytometric findings? Clinical presentation?
- Defect in Fas/CD95/Apo-1 mediated apoptosis; CD4-/CD8-, CD25-, CD45RO-, CD3+, CD57+
- LAD and splenomegaly in healthy child progresses to cytopenias
Sequence of abnormal lab values in iron deficiency anemia with respect to ferritin, transferrin, serum Fe, ZPP, and MCV?
↓ferritin → ↓serum Fe → ↑ZPP→ ↓Hb → ↓MCV
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