Deck 21: The Lymphomas

Question 1

The malignant lymphomas are divided into which major categories?

A) Hodgkin's lymphoma (disease) and non-Hodgkin's lymphomas (lymphocytic lymphomas)
B) Reticulum cell sarcomas lymphocytic lymphomas
C) Nodal and extracellular lymphomas
D) All of the above
E) None of the above

Answer 1

Hodgkin's lymphoma (disease) and non-Hodgkin's lymphomas (lymphocytic lymphomas)

Question 2

The selection of appropriate therapy for Hodgkin's lymphoma is most directly related to:

A) Histologic subtype
B) Stage of the disease
C) Age of the patient
D) All of the above
E) None of the above

Answer 2

Stage of the disease

Question 3

Which of the following are diseases in which Reed-Sternberg-like cells have been reported?

A) Melanoma
B) Viral infection
C) Myeloproliferative disorders
D) Stromal malignancies
E) All of the above

Answer 3

All of the above

Question 4

In __________, Reed-Sternberg cells and Reed-Sternberg variants predominate; and lymphocytes are sparse.

A) Lymphocyte predominance Hodgkin's lymphoma
B) Lymphocyte depletion Hodgkin's lymphoma
C) Mixed cellularity Hodgkin's lymphoma
D) Nodular sclerosing Hodgkin's lymphoma
E) Lymphocyte-rich classic Hodgkin's lymphoma

Question 5

All of the following are conditions associated with an increased risk of developing non-Hodgkin's lymphoma except:

A) Sjögren's syndrome
B) Sarcoidosis
C) Niemann-Pick disease
D) Systemic lupus erythematosus
E) AIDS

Question 6

A commonly used classification scheme for Hodgkin's lymphoma is:

A) Ann Arbor
B) Rappaport
C) Rye
D) Reed-Sternberg
E) None of the above

Question 7

An asymptomatic mediastinal mass affecting a young female is a common form of presentation for which form of Hodgkin's lymphoma?

A) Lymphocyte-rich classic Hodgkin's lymphoma
B) Lymphocyte-predominant Hodgkin's lymphoma
C) Mixed cellularity Hodgkin's lymphoma
D) Lymphocyte-depleted Hodgkin's lymphoma
E) Nodular sclerosing Hodgkin's lymphoma

Question 8

The diagnosis of Hodgkin's lymphoma requires a __________ and microscopic evaluation.

A) Bone marrow aspirate
B) Tissue biopsy
C) Bone marrow biopsy
D) Peripheral blood smear
E) None of the above

Question 9

The most widely used staging system for Hodgkin's lymphoma is the __________ classification.

A) Rye
B) Rappaport
C) Ann Arbor
D) Lukes and Butler
E) None of the above

Question 10

The morphologic hallmark of Hodgkin's lymphoma is a peculiar cell called the __________ cell.

A) Ann Arbor
B) Reed-Sternberg
C) Hairy cell
D) Rappaport
E) None of the above

Question 11

The accepted etiology for non-Hodgkin's lymphoma is damage to the regions of genetic code that regulate the growth and reproduction of cells of the immune system. What mutagenic factor(s) play(s) a role in initiation of this damage?

A) Chemicals
B) Ionizing radiation
C) Viruses
D) All of the above
E) None of the above

Question 12

What current view is accepted as the etiology for Hodgkin's disease?

A) A malignant proliferation of Reed-Sternberg cells and their variants
B) A benign proliferation of Reed-Sternberg cells and their variants
C) A malignant proliferation of plasmacytoid lymphocytes and their variants
D) A benign proliferation of plasmacytoid lymphocytes and their variants
E) None of the above

Question 13

Most patients with Hodgkin's lymphoma present with which symptom?

A) Fever
B) Painless lymph node swelling
C) Fatigue
D) Pallor
E) None of the above

Question 14

The most frequently occurring subtype of Hodgkin's lymphoma is:

A) Lymphocyte rich classic Hodgkin's lymphoma
B) Lymphocyte predominant
C) Mixed cellularity Hodgkin's lymphoma
D) Lymphocyte depleted Hodgkin's lymphoma
E) Nodular sclerosing Hodgkin's lymphoma

Question 15

Which name is given to the Reed-Sternberg variant cell seen in nodular sclerosing (NS) Hodgkin's lymphoma?

A) Lacunar cell
B) Mott cells
C) Warthin-Finkeldey cell
D) L and H cell
E) Monocytoid B cell

Question 16

Which of the following are morphological characteristics of the Reed-Sternberg cell?

A) Up to 45 µm in diameter
B) Multinucleated nucleus
C) Distinct halo around macronucleoli
D) None of the above
E) All of the above

Question 17

With appropriate therapy the 10-year survival of Stage I and II Hodgkin's lymphoma is:

A) 0%
B) Less than 50%
C) Greater than 80%
D) 100%
E) None of the above

Question 18

Which infectious agent is most commonly associated with the pathogenesis of Hodgkin's disease?

A) Echo virus
B) Herpes virus
C) Helicobacter pylori
D) Epstein-Barr virus
E) Picornavirus

Question 19

Which Ann Arbor stage corresponds to disseminated involvement of extralymphatic organs with associated lymph node involvement?

A) Stage I
B) Stage II
C) Stage III
D) Stage IV
E) None of the above

Question 20

Which of the following cell types are commonly found in mixed cellularity Hodgkin's disease?

A) Lymphocytes
B) Histiocytes
C) Plasma cells
D) Reed-Sternberg cells
E) All of the above

Question 21

What is the morphologic characterization of the malignant cells in lymphomas composed of small cleaved lymphocytes?

A) 6-12 µm in diameter
B) Clefted nucleus
C) Indistinct nucleoli
D) Small amount of cytoplasm
E) All of the above

Question 22

The immunophenotyping definition of B cell monoclonality is:

A) Clonal rearrangement of the IgH gene
B) Loss of B-cell antigens by the malignant cells
C) Expression of a single light chain class
D) Expression of a single heavy chain class
E) Clonal rearrangement of the light chain gene

Question 23

Non-Hodgkin's lymphomas are thought to be derived from lymphocytes present in the following lymph node compartments:

A) Intrafollicular
B) Mantle zone
C) Marginal zone
D) Interfollicular
E) All of the above

Question 24

Small lymphocytic lymphoma is characterized by all of the following except:

A) Indolent but incurable
B) Usually CD19+, CD5+, CD23+, CD10-
C) Growth centers
D) t(14;18)
E) Trisomy 12

Question 25

The lymphomas derived from intrafollicular lymphocytes most often express a(n) __________ phenotype.

A) T-cell
B) B-cell
C) Null killer (NK) cell
D) Null cell
E) None of the above

Question 26

Which of the following are T-cell disorders?

A) Mycosis fungoides
B) Sézary's syndrome
C) Hepatosplenic gamma/delta lymphoma
D) Angioimmunoblastic lymphadenopathy with dysproteinemia (AILD)-like T-cell lymphoma
E) All of the above

Question 27

What name is given to the abnormal growth-regulating genes that on activation-deregulation play a major role in development of most lymphomas?

A) Proto-oncogene
B) Oncogene
C) c-myc gene
D) All of the above
E) None of the above

Question 28

Translocations involving the bcl-1 and IgH genes are commonly associated with which low-grade B cell lymphoma?

A) Small lymphocytic
B) Immunocytoma
C) Mantle cell
D) Marginal cell
E) None of the above

Question 29

A lymphoma associated with infection by a type C retrovirus is:

A) Endemic to Japan
B) Associated with hypercalcemia
C) Usually rapidly fatal
D) All of the above
E) None of the above

Question 30

Alternatives to karyotypic analysis for the demonstration of chromosomal translocations include:

A) Southern blot analysis
B) Polymerase chain reaction
C) Fluorescence in situ hybridization
D) All of the above
E) None of the above

Question 31

What is the characteristic location of the tumor in endemic Burkitt's lymphoma of young children?

A) Pancreas
B) Abdominal
C) Facial
D) Liver
E) None of the above

Question 32

All follicular center lymphomas are composed of a mixture of:

A) Small cleaved and small non-cleaved cells
B) Centrocytes (small cleaved) and centroblasts (large non-cleaved) cells
C) Large cleaved cells and immunoblasts
D) Prolymphocytes and immunoblasts
E) All of the above

Question 33

The diffuse aggressive lymphomas are:

A) Seldom curable
B) Rapidly fatal if untreated
C) Best treated with a combination of surgery and radiotherapy
D) Single-agent chemotherapy is the treatment of choice.
E) All of the above

Question 34

Which of the following is true regarding the low-grade non-Hodgkin's lymphomas?

A) Survival without treatment averages greater than 5 years.
B) Disease is usually advanced at diagnosis.
C) Multiagent chemotherapy can prolong survival.
D) Usually express B-cell phenotype
E) All of the above

Question 35

Mucosa-associated lymphoid tissue (MALT) lymphomas are characterized by all of the following except:

A) Extranodal involvement
B) Associated follicular hyperplasia
C) CD19+, CD5+, CD10+, phenotype
D) t(11;18)
E) Indolent behavior

Question 36

Which type of malignant cell infiltrates the dermis and epidermis in Sézary syndrome and mycosis fungoides?

A) T cell
B) B cell
C) Hairy cell
D) Plasma cell
E) Null cell

Question 37

Lymphoblastic lymphomas are associated with which of the following?

A) High frequency of developing acute lymphoblastic leukemia
B) Mediastinal mass
C) Potentially curable in young patients
D) Usually terminal deoxynucleotidyl transferase (TdT) positive
E) All of the above

Question 38

Burkitt's lymphoma is histologically characterized by which of the following?

A) Uniform nuclei
B) High mitotic rate
C) "Starry sky" pattern
D) All of the above
E) None of the above

Question 39

Which classification system is most often used by clinicians in the characterization of non-Hodgkin's lymphoma?

A) Rye
B) Working formulation
C) Ann Arbor
D) Lukes and Butler
E) None of the above

Question 40

A lymphoma expressing a monoclonal B-cell phenotype with coexpression of CD10 and rearrangement of the bcl-2 gene is most likely derived from:

A) Follicular center cells
B) Mantle cells
C) Marginal zone cells
D) Interfollicular cells
E) None of the above

Question 41

The Ann Arbor staging system is used for all non-Hodgkin's lymphoma disorders except:

A) Burkitt's lymphoma
B) Immunoblastic lymphoma
C) Lymphoblastic lymphoma
D) Cutaneous T-cell lymphoma
E) None of the above