LATEST PATHOLOGY - HEMATOPATHOLOGY
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PATHOLOGY (ABMS) |
COMPLETE EXAM Q&A WITH RATIONALES
1. A 55-year-old man presents with painless
lymphadenopathy in the neck and axillae. Excisional
biopsy shows effacement of lymph node architecture
by large nodules containing small lymphocytes,
histiocytes, and scattered large cells with
multilobated "popcorn" nuclei. The large cells are
CD20+, CD30-, CD15-, and EBV-. What is the most
likely diagnosis?
A) Nodular sclerosis classical Hodgkin lymphoma
B) Nodular lymphocyte predominant Hodgkin
lymphoma (NLPHL)
C) Mixed cellularity classical Hodgkin lymphoma
D) Follicular lymphoma
Correct answer: B
Rationale: NLPHL shows nodular growth with
lymphocyte predominant (LP) cells (popcorn cells)
that are CD20+, CD30-, CD15-, and EBV-. It has an
indolent course and is often CD20-targeted. Classic
Hodgkin lymphoma (A,C) has Reed-Sternberg cells
(CD30+, CD15+, CD20-).
,2. A 68-year-old man presents with fatigue and
splenomegaly. Complete blood count shows
leukocytosis (WBC 120,000/μL) with neutrophilic
predominance, including myelocytes and
metamyelocytes. Basophilia is present. Platelets are
450,000/μL. What is the most likely diagnosis?
A) Chronic myeloid leukemia (CML)
B) Polycythemia vera
C) Chronic neutrophilic leukemia
D) Leukemoid reaction
Correct answer: A
Rationale: CML presents with marked leukocytosis,
full spectrum of myeloid precursors (left shift),
basophilia, and often thrombocytosis. Philadelphia
chromosome t(9;22) and BCR-ABL1 fusion are
diagnostic. Leukemoid reaction (D) lacks basophilia
and has negative BCR-ABL.
3. A 45-year-old woman presents with abdominal pain
and early satiety. CT shows splenomegaly. CBC
shows hemoglobin 10 g/dL, platelets 80,000/μL, and
WBC 12,000/μL with 15% circulating villous
lymphocytes with cytoplasmic projections. Bone
marrow biopsy shows lymphoid aggregates with
,sinusoidal infiltration. Immunophenotype: CD20+,
CD5-, CD23-, cyclin D1-, and CD103+. What is the
most likely diagnosis?
A) Chronic lymphocytic leukemia (CLL)
B) Hairy cell leukemia (HCL)
C) Splenic marginal zone lymphoma (SMZL)
D) Mantle cell lymphoma (MCL)
Correct answer: C
Rationale: SMZL presents with splenomegaly, villous
lymphocytes (short villi), and bone marrow sinusoidal
infiltration. Immunophenotype: CD20+, CD5-, CD23-,
cyclin D1-, CD103- (unlike HCL, which is CD103+ and
has long villi). BRAF mutation negative.
4. A 32-year-old man presents with a rapidly
enlarging neck mass. Excisional biopsy shows a
diffuse proliferation of medium-sized lymphocytes
with squared-off nuclei, multiple small nucleoli, and a
starry-sky pattern. The cells are CD20+, CD10+,
BCL6+, and MYC+ (90%). Ki-67 is 100%. MYC
rearrangement is present; BCL2 and BCL6
rearrangements are absent. What is the most likely
diagnosis?
A) Burkitt lymphoma
B) Diffuse large B-cell lymphoma (DLBCL)
, C) High-grade B-cell lymphoma with MYC and BCL2
rearrangements
D) Follicular lymphoma grade 3B
Correct answer: A
Rationale: Burkitt lymphoma has medium-sized cells,
squared-off nuclei, starry-sky pattern (tingible-body
macrophages), high Ki-67 (100%), and MYC
rearrangement without BCL2/BCL6 rearrangements
(sporadic form). Endemic form is EBV+. Double-hit
lymphoma (C) has MYC plus BCL2 rearrangements.
5. A 60-year-old woman presents with fatigue and
back pain. CBC shows hemoglobin 8 g/dL, MCV 110
fL, WBC 3,500/μL, platelets 90,000/μL. Peripheral
smear shows macro-ovalocytes and hypersegmented
neutrophils (≥5 lobes). What is the most likely
diagnosis?
A) Folate deficiency
B) Vitamin B12 deficiency
C) Myelodysplastic syndrome
D) Aplastic anemia
Correct answer: B
Rationale: Macrocytic anemia with hypersegmented
neutrophils is classic for vitamin B12 or folate
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PATHOLOGY (ABMS) |
COMPLETE EXAM Q&A WITH RATIONALES
1. A 55-year-old man presents with painless
lymphadenopathy in the neck and axillae. Excisional
biopsy shows effacement of lymph node architecture
by large nodules containing small lymphocytes,
histiocytes, and scattered large cells with
multilobated "popcorn" nuclei. The large cells are
CD20+, CD30-, CD15-, and EBV-. What is the most
likely diagnosis?
A) Nodular sclerosis classical Hodgkin lymphoma
B) Nodular lymphocyte predominant Hodgkin
lymphoma (NLPHL)
C) Mixed cellularity classical Hodgkin lymphoma
D) Follicular lymphoma
Correct answer: B
Rationale: NLPHL shows nodular growth with
lymphocyte predominant (LP) cells (popcorn cells)
that are CD20+, CD30-, CD15-, and EBV-. It has an
indolent course and is often CD20-targeted. Classic
Hodgkin lymphoma (A,C) has Reed-Sternberg cells
(CD30+, CD15+, CD20-).
,2. A 68-year-old man presents with fatigue and
splenomegaly. Complete blood count shows
leukocytosis (WBC 120,000/μL) with neutrophilic
predominance, including myelocytes and
metamyelocytes. Basophilia is present. Platelets are
450,000/μL. What is the most likely diagnosis?
A) Chronic myeloid leukemia (CML)
B) Polycythemia vera
C) Chronic neutrophilic leukemia
D) Leukemoid reaction
Correct answer: A
Rationale: CML presents with marked leukocytosis,
full spectrum of myeloid precursors (left shift),
basophilia, and often thrombocytosis. Philadelphia
chromosome t(9;22) and BCR-ABL1 fusion are
diagnostic. Leukemoid reaction (D) lacks basophilia
and has negative BCR-ABL.
3. A 45-year-old woman presents with abdominal pain
and early satiety. CT shows splenomegaly. CBC
shows hemoglobin 10 g/dL, platelets 80,000/μL, and
WBC 12,000/μL with 15% circulating villous
lymphocytes with cytoplasmic projections. Bone
marrow biopsy shows lymphoid aggregates with
,sinusoidal infiltration. Immunophenotype: CD20+,
CD5-, CD23-, cyclin D1-, and CD103+. What is the
most likely diagnosis?
A) Chronic lymphocytic leukemia (CLL)
B) Hairy cell leukemia (HCL)
C) Splenic marginal zone lymphoma (SMZL)
D) Mantle cell lymphoma (MCL)
Correct answer: C
Rationale: SMZL presents with splenomegaly, villous
lymphocytes (short villi), and bone marrow sinusoidal
infiltration. Immunophenotype: CD20+, CD5-, CD23-,
cyclin D1-, CD103- (unlike HCL, which is CD103+ and
has long villi). BRAF mutation negative.
4. A 32-year-old man presents with a rapidly
enlarging neck mass. Excisional biopsy shows a
diffuse proliferation of medium-sized lymphocytes
with squared-off nuclei, multiple small nucleoli, and a
starry-sky pattern. The cells are CD20+, CD10+,
BCL6+, and MYC+ (90%). Ki-67 is 100%. MYC
rearrangement is present; BCL2 and BCL6
rearrangements are absent. What is the most likely
diagnosis?
A) Burkitt lymphoma
B) Diffuse large B-cell lymphoma (DLBCL)
, C) High-grade B-cell lymphoma with MYC and BCL2
rearrangements
D) Follicular lymphoma grade 3B
Correct answer: A
Rationale: Burkitt lymphoma has medium-sized cells,
squared-off nuclei, starry-sky pattern (tingible-body
macrophages), high Ki-67 (100%), and MYC
rearrangement without BCL2/BCL6 rearrangements
(sporadic form). Endemic form is EBV+. Double-hit
lymphoma (C) has MYC plus BCL2 rearrangements.
5. A 60-year-old woman presents with fatigue and
back pain. CBC shows hemoglobin 8 g/dL, MCV 110
fL, WBC 3,500/μL, platelets 90,000/μL. Peripheral
smear shows macro-ovalocytes and hypersegmented
neutrophils (≥5 lobes). What is the most likely
diagnosis?
A) Folate deficiency
B) Vitamin B12 deficiency
C) Myelodysplastic syndrome
D) Aplastic anemia
Correct answer: B
Rationale: Macrocytic anemia with hypersegmented
neutrophils is classic for vitamin B12 or folate
