Pathology Student

Another quiz – this time on acute leukemia. Answers and explanations are in the first comment following this post.

1. Patients with which of the following leukemias may go into DIC if given routine chemotherapeutic agents?

A. Acute promonocytic leukemia
B. Acute promyelocytic leukemia
C. Acute lymphoblastic leukemia
D. Chronic myeloid leukemia
E. Chronic lymphocytic leukemia

2. All of the following terms are technically incorrect, EXCEPT:

A. Acute lymphocytic leukemia
B. Chronic myeloblastic leukemia
C. Chronic lymphoid leukemia
D. Leukemoid reaction
E. Chronic myeloid leukemia

3. Which of the following leukemias is likely to show a panmyelosis:

A. Acute lymphoblastic leukemia
B. Acute monoblastic leukemia
C. Acute erythroblastic leukemia
D. Chronic lymphocytic leukemia
E. Chronic myeloid leukemia

4. A bone marrow biopsy shows 5% myeloblasts and some funny-looking neutrophils and precursors. The most likely diagnosis is:

A. Acute myeloid leukemia
B. Acute lymphoblastic leukemia
C. Myelodysplastic syndrome
D. Bacterial infection
E. Chronic myeloid leukemia

5. While looking around a blood smear, you notice a blast with an Auer rod in it. This patient has:

A. A bacterial infection
B. No disease, unless 20% of the nucleated cells have Auer rods
C. A myelodysplastic syndrome
D. Acute myeloid leukemia
E. Acute lymphoblastic leukemia

6. Acute lymphoblastic leukemia:

A. Often has a good prognosis
B. Never occurs in children
C. Is classified according to morphologic appearance
D. Is only diagnosed when 20% or more of the nucleated cells are lymphoblasts
E. Is an indolent disease

7. Which of the following is a GOOD prognostic indicator in acute lymphoblastic leukemia?

A. Age less than 1
B. A WBC >10,000
C. B-lineage immunophenotype
D. Normal cytogenetics
E. Age >10

 

Just as there are many different types of myeloid cells (neutrophils, red cells, monocytes, eosinophils, basophils), there are many different types of acute myeloid leukemia (AML). Two types of AML are composed almost entirely of cells of the monocytic series: acute monoblastic leukemia and acute monocytic leukemia. In both of these types of AML, at least 80% of the leukemic cells are from the monocytic series (monoblasts, promonocytes, and monocytes). In acute monoblastic leukemia, most of these cells are monoblasts, and in acute monocytic leukemia, most of these cells are promonocytes. Promonocytes have a very characteristic appearance, as shown above. They have nuclei that show a delicate folding pattern, almost like a piece of tissue paper that has been crumpled a bit. If you had a case of acute leukemia and most of the cells looked like this, you would think about acute monocytic leukemia – and you’d get an NSE to prove it.