Pathology EMQ template.

Name: Ufuk Cengel             

Theme: Chronic Lymphocytic Leukaemia

 

OPTION LIST

 

A	Chronic Lymphocytic Leukaemia (CLL)	I	Non-Hodgkin’s Lymphoma
B	Acute Lymphoblastic Leukaemia	J	Richter Transformation
C	Hairy Cell Leukaemia	K	ZAP70 & CD38
D	T Pro-lymphocytic leukaemia	L	CD5 & CD23
E	Reactive Lymphocytosis	M	CD79b & FMC7
F	Mantle Cell Lymphoma	N	CD28 & CD3
G	Lymphoblastic Lymphoma	O	SHC1 & CD40L
H	Hodgkin’s Lymphoma	P	Previous Mistaken Diagnosis

 

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

 

1.  A 55 year old Caucasian male attends your GP clinic complaining of tiredness and a swollen and painful neck. On examination you find lymphadenopathy. A FBC shows lymphocytosis and you notice from his records that he is being treated for Herpes Zoster infection.

 

 

2. A 75 year old male is referred to your Haematology clinic presenting with lymphadenopathy, fever, and malaise. A blood film shows very large lymphocytes up to 4x larger than normal with moderate cytoplasm. These cells were identified as B-lymphocytes and immunophenotyping demonstrated kappa light chain production only, as well strong surface immunoglobulin expression.

 

 

3. Expression of which two proteins is associated with a significantly worse prognosis in chronic lymphocytic leukaemia?

 

 

4. Which two proteins if positive on immunophenotyping of B cells would suggest chronic lymphocytic leukaemia?

 

 

5. A GP refers a patient with a previous history of untreated mild CLL to your Haematology clinic. You request your standard set of investigations and are surprised to find very large B-cells on the blood film suggestive of large B-cell lymphoma. You are bewildered and struggle to explain the change in pathology.

 

 

 

ANSWERS

1. E

2. I

3. K

4. L

5. J