Department of Pathology, State University of New York at Stony Brook


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Morphologic Quiz

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1) In reference to the above image, the best diagnosis is:
  1. Small non-cleaved cell lymphoma.
  2. Small lymphocytic lymphoma.
  3. Lymphocyte predominance Hodgkin's lymphoma.
  4. Large cell lymphoma.

2) With regard to Hodgkin's lymphoma:

  1. It is more common than non-Hodgkin's lymphoma.
  2. Its incidence in the U.S. peaks in 2 different age groups.
  3. There is no association with Epstein-Barr virus.
  4. Its epidemiology is similar in developed and developing countries.

3) In regard to the age distribution of lymphomas:

  1. Non-Hodgkin's lymphomas in general are more common in young adults and children than in older patients.
  2. Multiple myeloma is primarily seen in older people.
  3. Indolent lymphomas such as small lymphocytic lymphoma and follicular small cleaved cell lymphoma are common in children.
  4. African Burkitt's lymphoma is primarily a disease of the elderly.

4) A true statement about lymphoma biology is:

  1. Lymphomas with a follicular growth pattern tend to be high-grade.
  2. As opposed to indolent lymphomas, aggressive lymphomas are incurable.
  3. The secreted products of lymphoid cells may contribute to the morbidity of lymphoid malignancies.
  4. Lymphoma cells have no normal counterparts.

5) The true statement about lymphoid cell behavior is:

  1. Indolent lymphomas show no response to chemotherapy.
  2. Indolent lymphomas have no tendency to become more agressive with time.
  3. Because plasma cells are terminally differentiated, there are no plasma cell malignancies.
  4. Unlike most normal cells, normal lymphoid cells undergo 2 proliferative, blastic bursts as they mature.

6) A true statement about lymphoma pathogenesisis is:

  1. Viruses, but not bacteria, have been implicated in lymphoma pathogenesis
  2. Any monoclonal plasma cell population in the marrow is diagnostic for multiple myeloma.
  3. Exposure to occupational toxins plays an major role in causing lymphomas.
  4. Two of the biggest risk factors for lymphoma are immunodefects and a family history of the disease.


7) In reference to the above image, the feature that might help establish that it represents part of a malignant follicle is:
  1. The presence of small-cleaved cells.
  2. The presence of a larger cell.
  3. The absence of tingible-body macrophages.
  4. The absence of plasma cells.

8) A true statement related to lymphoma classification is:

  1. Immunophenotyping, cytogenetics, and molecular techniques may all play a role in classifying lymphomas.
  2. Currently morphologic analysis has been supplanted by more scientific methods.
  3. In the Working Formulation, diffuse large-cell lymphoma is high-grade.
  4. Nodular lymphocyte predominance is a subtype of classical Hodgkin's lymphoma.

9) The immunology of non-Hodgkin's lymphoma:

  1. Kappa:lambda light chain ratios help identify T-cell lymphomas.
  2. Immunohistochemistry, immunofluorescence, and flow cytometry are all ways of identifying antigens on a cell.
  3. Typical B-cells are positive for CD2, CD3, CD5, and CD7 antigens.
  4. Typical T-cells are positive for CD19, CD20, and CD22 antigens.

10) In regard to laboratory techniques for lymphoma diagnosis:

  1. A kappa:lambda ratio markedly different than 2:1 is suggestive of a benign, polyclonal lymphoid proliferation.
  2. CD (Cluster Designation) numbers are alternative names for different types of lymphomas.
  3. An immunophenotype of a lymphoma is description of the antigens that the lymphoma characteristically does and doesn't express.
  4. Clonal rearrangements of immunoglobulin or T-cell receptor genes are usually detected by conventional cytogenetics.

11) The correct association is between:

  1. a rearrangement involving CyclinD1/BCL-1/PRAD-1 (different names for the same gene) and small lymphocytic lymphoma.
  2. an 8:14 translocation of the c-myc gene and anaplastic large cell lymphoma.
  3. a 14:18 translocation of the bcl-2 gene and follicular lymphoma.
  4. a 2:5 translocation and Burkitt's lymphoma.

12) In in reference to the above image of a formalin-fixed mass, the large cells with contracted or apparently absent cytoplasm suggest the following subtype of Hodgkin's disease:
  1. Nodular sclerosis.
  2. Nodular lymphocyte predominance.
  3. Mixed cellularity.
  4. Lymphocyte depletion.

13) A true statement about lymphoma cells is:

  1. Small-cleaved cells are seen mainly in small lymphocytic lymphoma
  2. Lymphoblasts have large, eosinophilic nucleoli.
  3. The plasma cells in multiple myeloma always appear mature.
  4. A diagnostic Reed-Sternberg cell has multiple nuclei with huge, red nucleoli.


14) In reference to the above image:
  1. It is sufficient evidence for a diagnosis of lymphoma.
  2. It is consistent with a diagnosis of small lymphocytic lymphoma.
  3. The cells are small-cleaved cells.
  4. The cells probably represent a high-grade lymphoma.

15) Concerning lymphoma architecture:

  1. A "starry sky" background is traditionally associated with Burkitt's or small non-cleaved cell lymphoma.
  2. Lymphoepithelial lesions in the GI tract are associated with T-cell lymphoma.
  3. All lymphomas with a follicular growth pattern are low-grade by the Working Formulation.
  4. Mycosis fungoides cells are confined to the dermis.

16) In Hodgkin's lymphoma as opposed to non-Hodgkin's lymphoma:

  1. Extranodal involvement is more frequent.
  2. Indolent cases are not always treated.
  3. The bulk of the mass consists of reactive, inflammatory cells.
  4. Immune deficiencies are usually humoral in nature.

17) In higher grade lymphomas (intermediate and high grade) as opposed to low grade lymphomas:

  1. Peripheral blood lymphocytosis is more common.
  2. Extranodal involvement is less common.
  3. Patients present more often with generalized lymphadenopathy.
  4. Nuclei are large with open or clear chromatin.

18) In B-cell lymphomas as opposed to T-cell lymphomas:

  1. Types include mycosis fungoides.
  2. Immunologically clonality can be demonstrated only by the abnormal absence of an antigen expressed on all normal B-cells.
  3. B-cell lymphomas are slightly less common.
  4. The pan-B-cell antigens CD19 and CD20 are usually present.

19) In regard to follicles in follicular lymphoma as opposed to a reactive germinal centers:

  1. Malignant follicles usually have a higher mitotic rate.
  2. Malignant follicles have thickened mantle-cell zones.
  3. Malignant follicles are more densely packed and monomorphic.
  4. Malignant follicles contain more tingible-body macrophages.

20) In regard to reactive lymph nodes:

  1. Lymph nodes involved by sarcoidosis feature necrotizing granulomas.
  2. Follicular hyperplasia, epithelioid histiocytes, and moncytoid B-cells characterize nodal toxoplasmosis.
  3. "Cat-scratch" disease is a misnomer, since in fact the disease is transmitted by dog-bites.
  4. The initial change seen in lymph nodes of patients with AIDS is lymphocyte depletion.

21) With monoclonal gammopathies of undetermined significance:

  1. A stable M-component < 3 grams/deciliter helps to exclude multiple myeloma.
  2. A marrow plasmacytosis > 25% helps to exclude multiple myeloma
  3. In most cases a bone marrow biopsy should follow the discovery of an M-component.
  4. Unlike multiple myeloma, the gammopathies tend to occur in a young population.

22) In Hodgkin's lymphoma, the correct association is between:

  1. "Popcorn" or L&H cells and nodular sclerosis.
  2. Lacunar cells and mixed-cellularity.
  3. More common in women and lymphocyte depletion.
  4. B-cell immunophenotype and nodular lymphocyte predominance.

23) In a normal, reactive lymph node:

  1. The follicles are located in the medulla.
  2. B-cells are found preferentially in the paracortex.
  3. A secondary follicle consists of a pale germinal center and a dark mantle zone.
  4. Antigen enters the node at the hilum.

24) In reference to the above image, the best diagnosis is:
  1. Hodgkin's lymphoma.
  2. Lymphoblastic lymphoma.
  3. Sarcoid.
  4. Large cell lymphoma.

25) About low-grade, diffuse, B-cell lymphomas:

  1. "Waldenstrom's macroglobulinemia" is another name for IgG-secreting plasmacytoid lymphomas.
  2. Gastric MALT lymphomas are associated with H. pylori infection.
  3. Mantle cell lymphoma has a better prognosis than most diffuse, low-grade lymphomas.
  4. Diffuse, low-grade lymphomas require agressive initial treatment.

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