Arya.Non-neoplastic Disorders ; Neoplasia; Hematology-1 & 2

1. A 35-year-old woman has had dull pelvic pain for a year. A pelvic CT scan shows a cystic mass involving the left adnexa. She is found at laparotomy to have a well-circumscribed 5 cm cystic mass in the left ovary. On sectioning the mass is filled with yellow-tan material and hair. Microscopy is shown below. What is your diagnosis?

Choriocarcinoma

Osteosarcoma

Teratoma

Hydatidiform mole

C. Correct. Teratoma is a benign tumor derived from germ cells.

A. Incorrect. Choriocarcinoma is a malignant tumor of placental epithelium arising in the uterus (and not ovary).
B. Incorrect. Osteosarcoma is a malignant tumor of bone, occurring in young children and adolescents. It usually occurs around the knee joint (lower end of femur or upper end of tibia).
D. Incorrect. Hydatidiform mole is a benign tumor of the placental villi.

Explanation

C. Correct. Teratoma is a benign tumor derived from germ cells.

A. Incorrect. Choriocarcinoma is a malignant tumor of placental epithelium arising in the uterus (and not ovary).
B. Incorrect. Osteosarcoma is a malignant tumor of bone, occurring in young children and adolescents. It usually occurs around the knee joint (lower end of femur or upper end of tibia).
D. Incorrect. Hydatidiform mole is a benign tumor of the placental villi.

2. A 65-year-old man has increasing shortness of breath on exertion. Physical examination reveals pallor and koilonychia. A complete blood count reveals the following. Hemoglobin – 8 g/dL Mean corpuscular volume – 72 µm3 Peripheral smear examination shows microcytic hypochromic red cells. Which of the following is the most likely cause of the anemia in this patient?

Iron deficiency

Folic acid deficiency

Vitamin B12 deficiency

Pernicious anemia

Alcoholism

A. Correct. Microcytic hypochromic anemia with a low MCV B ,C, D, E. Incorrect. All these options are associated with macrocytic anemia and a high MCV > 100.

Explanation

A. Correct. Microcytic hypochromic anemia with a low MCV B ,C, D, E. Incorrect. All these options are associated with macrocytic anemia and a high MCV > 100.

3. A 27-year-old woman in excellent health has a routine health maintenance examination. A 2-cm rounded mass is palpable beneath the skin of the left forearm. The mass on excision is yellow, soft and shows a benign tumor composed of adipocytes. What is your diagnosis?

Fibroadenoma

Melanoma

Rhabdomyosarcoma

Lipoma

Leiomyoma

D. Correct. Lipoma is a benign tumor of adipocytes.

A. Incorrect. Fibroadenoma is a benign tumor of the breast; it is composed of fibroblasts and glandular tissue. This tumor is seen in young females; the growth is small, painless and freely mobile.
B. Incorrect. Melanoma is a malignant tumor arising from melanocytes, not adipocytes.
C. Incorrect. Rhabdomyosarcoma is a malignant tumor composed of skeletal muscle.
E. Incorrect. Leiomyoma is a benign tumor composed of smooth muscle. The most common site is the uterus.

Explanation

D. Correct. Lipoma is a benign tumor of adipocytes.

A. Incorrect. Fibroadenoma is a benign tumor of the breast; it is composed of fibroblasts and glandular tissue. This tumor is seen in young females; the growth is small, painless and freely mobile.
B. Incorrect. Melanoma is a malignant tumor arising from melanocytes, not adipocytes.
C. Incorrect. Rhabdomyosarcoma is a malignant tumor composed of skeletal muscle.
E. Incorrect. Leiomyoma is a benign tumor composed of smooth muscle. The most common site is the uterus.

4. A 14-year-old healthy girl has a 0.3 cm reddish, slightly raised nodule on the skin of the upper part of her chest found on a routine examination. The tumor shows a benign proliferation of blood vessels. Which of the following neoplasms is this nodule most likely to be?

Hemangioma

Melanoma

Mesothelioma

Lymphoma

Meningioma

A Correct. Hemangioma is a benign tumor composed of blood vessels.
B Incorrect. Melanoma is a malignant tumor arising from melanocytes.
C Incorrect. Mesothelioma is a malignant tumor arising from mesothelial cells.
D Incorrect. Lymphoma is a malignant tumor of lymphoid cells within the lymph nodes.
E Incorrect. Meningioma is a benign tumor of meningothelial cells.

Explanation

A Correct. Hemangioma is a benign tumor composed of blood vessels.
B Incorrect. Melanoma is a malignant tumor arising from melanocytes.
C Incorrect. Mesothelioma is a malignant tumor arising from mesothelial cells.
D Incorrect. Lymphoma is a malignant tumor of lymphoid cells within the lymph nodes.
E Incorrect. Meningioma is a benign tumor of meningothelial cells.

5. A 40-year-old woman has had abdominal discomfort for past 8 months. On pelvic examination, there is a right adnexal mass. An abdominal CT scan shows s a 7 cm cystic mass involving right ovary with small areas of calcification. Uterus is normal in size. Right fallopian tube and ovary are removed surgically. Grossly, the mass on sectioning is filled with abundant hair and sebum. M/S reveals a mass with glandular spaces lined by columnar epithelium, squamous epithelium with hair follicles, cartilage, and dense connective tissue. What is your diagnosis?

Melanoma

Mesothelioma

Teratoma

Hamartoma

Choristoma

C. Correct. The image shows a cystic tumor with presence of hair and bone. Microscopy describes a tumor derived from > 1 germ cell layer – Benign epithelial tissue (glands, squamous epithelium) and mesenchymal tissue (cartilage, dense connective tissue). This is a classical teratoma (also known as a dermoid cyst).
A. Incorrect. Melanoma is a malignant tumor arising from melanocytes; occurs on the skin.
B. Incorrect. Mesothelioma is a malignant tumor arising from mesothelial cells lining the pleural cavity.
D. Incorrect. Hamartoma is a tumor-like condition, composed of disorganized tissue masses. It is more often located in lungs, colon or spleen.
E. Incorrect. Choristoma is a heterotopic rest of tissue or an ectopic location of normal tissue.

Explanation

C. Correct. The image shows a cystic tumor with presence of hair and bone. Microscopy describes a tumor derived from > 1 germ cell layer – Benign epithelial tissue (glands, squamous epithelium) and mesenchymal tissue (cartilage, dense connective tissue). This is a classical teratoma (also known as a dermoid cyst).
A. Incorrect. Melanoma is a malignant tumor arising from melanocytes; occurs on the skin.
B. Incorrect. Mesothelioma is a malignant tumor arising from mesothelial cells lining the pleural cavity.
D. Incorrect. Hamartoma is a tumor-like condition, composed of disorganized tissue masses. It is more often located in lungs, colon or spleen.
E. Incorrect. Choristoma is a heterotopic rest of tissue or an ectopic location of normal tissue.

6. A 5-year-old girl presents with a 2-3 day history of localized swelling in the right side of her neck. Physical examination shows very tender, firm, slightly enlarged lymph nodes in the right cervical region. CBC shows mild leukocytosis. Which of the following is the most likely diagnosis?

Chronic lymphadenitis

Acute bacterial lymphadenitis

Lymphoma

Metastatic cancer

B. Correct. Painful localized LN suggest acute bacterial infection in the tonsils.

A. Incorrect. Tuberculous lymphadenitis is a chronic condition generally presents with a painless lymphadenopathy.
C. Incorrect. Lymphoma is a malignancy arising from the lymphoid cells within the lymph node. These are generally painless.
D. Incorrect. Metastatic cancer is a cancer that has arisen elsewhere and has subsequently spread to the lymph nodes. These are generally painless.

Explanation

B. Correct. Painful localized LN suggest acute bacterial infection in the tonsils.

A. Incorrect. Tuberculous lymphadenitis is a chronic condition generally presents with a painless lymphadenopathy.
C. Incorrect. Lymphoma is a malignancy arising from the lymphoid cells within the lymph node. These are generally painless.
D. Incorrect. Metastatic cancer is a cancer that has arisen elsewhere and has subsequently spread to the lymph nodes. These are generally painless.

7. Which of the following is correct regarding classification and nomenclature of neoplasms?

A hamartoma is a benign tumor of glandular epithelium

A carcinoma is an epithelial malignancy

Liposarcoma is a malignant tumor of skeletal muscle

A choristoma is a benign tumor of adipose tissue

B. Correct.
A. Incorrect. A benign tumor of glandular epithelium is an adenoma. A hamartoma is a growth composed of disorganized tissue.
C. Incorrect. Liposarcoma is a malignant tumor of adipocytes. A malignant tumor of skeletal muscle is known as a rhabdomyosarcoma.
D. Incorrect. A choristoma is a heterotopic rest of tissue or an ectopic location of normal tissue. A benign tumor of adipose tissue is a lipoma.

Explanation

B. Correct.
A. Incorrect. A benign tumor of glandular epithelium is an adenoma. A hamartoma is a growth composed of disorganized tissue.
C. Incorrect. Liposarcoma is a malignant tumor of adipocytes. A malignant tumor of skeletal muscle is known as a rhabdomyosarcoma.
D. Incorrect. A choristoma is a heterotopic rest of tissue or an ectopic location of normal tissue. A benign tumor of adipose tissue is a lipoma.

8. A 7-year-old boy complains of groin pain since past few days. Painful, swollen lymph nodes in right inguinal region are noted. Lymph node biopsy shows follicular enlargement and hyperemia. Sinuses are filled with neutrophils.. What is the most likely cause of these histological changes?

Acute lymphadenitis

Lymphoma

Leukemia

Metastatic carcinoma

Chronic lymphadenitis

A. Correct. Painful and acute enlarged nodes suggest a reactive condition and not a neoplastic process, like lymphoma, leukemia or a metastatic carcinoma. In children, enlarge tender nodes and acute lymphadenitis are common. Children often get cuts on extremities, which can become infected.

Explanation

A. Correct. Painful and acute enlarged nodes suggest a reactive condition and not a neoplastic process, like lymphoma, leukemia or a metastatic carcinoma. In children, enlarge tender nodes and acute lymphadenitis are common. Children often get cuts on extremities, which can become infected.

9. A 35-year-old woman had a firm nodule palpable on the dome of the uterus six years ago recorded on routine physical examination. The nodule has slowly increased in size and is now about twice the size when first discovered. She remains asymptomatic. Which of the following neoplasms is she most likely to have?

Adenocarcinoma

Rhabdomyoma

Seminoma

Leiomyoma

Hepatocellular carcinoma

(D) Correct. Slow growth of nodule and lack of symptoms suggests a benign course. Leiomyomas of uterus are quite common (20% of women).
A. Incorrect. Adenocarcinomas are malignant epithelial tumors arising from glands.
B. Incorrect. Rhabdomyomas are benign tumors of skeletal muscle origin.
C. Incorrect. Seminoma is a malignant tumor of the testes arising from germ cells.
E. Incorrect. Hepatocellular carcinoma is a malignant epithelial tumor arising from hepatocytes.

Explanation

(D) Correct. Slow growth of nodule and lack of symptoms suggests a benign course. Leiomyomas of uterus are quite common (20% of women).
A. Incorrect. Adenocarcinomas are malignant epithelial tumors arising from glands.
B. Incorrect. Rhabdomyomas are benign tumors of skeletal muscle origin.
C. Incorrect. Seminoma is a malignant tumor of the testes arising from germ cells.
E. Incorrect. Hepatocellular carcinoma is a malignant epithelial tumor arising from hepatocytes.

10. A 51-year-old woman has been feeling tired for past 7 months. O/E- Decreased sensation to light touch and pin-prick over lower extremities. CBC shows Hb 9.5 g/dL, Hct 29.1%, MCV 124 fL, platelets 250,000/µL, WBC count 8200/µL. Reticulocyte count - 0.5%. Hyper-segmented neutrophils seen on PBS. Which laboratory test is most appropriate to order next on this woman?

Serum B12 and folate

Bone marrow biopsy

Serum ferritin

Hemoglobin electrophoresis

A. CORRECT. The markedly elevated MCV suggests a megaloblastic anemia, and the hypersegmented PMN's are consistent with this. Either a B12 or a folate deficiency is the likely cause.
B. Incorrect. A bone marrow biopsy should not be performed as an initial test when a non-invasive study will yield a clear answer. However, it could be used if other investigations prove inconclusive.
C. Incorrect. The serum ferritin is the most sensitive indicator of storage iron. The serum ferritin would be low with iron deficiency anemia and high with liver disease or iron storage diseases.
D. Incorrect. This test is useful for hemoglobinopathies such as sickle cell anemia or thalassemia.

Explanation

A. CORRECT. The markedly elevated MCV suggests a megaloblastic anemia, and the hypersegmented PMN's are consistent with this. Either a B12 or a folate deficiency is the likely cause.
B. Incorrect. A bone marrow biopsy should not be performed as an initial test when a non-invasive study will yield a clear answer. However, it could be used if other investigations prove inconclusive.
C. Incorrect. The serum ferritin is the most sensitive indicator of storage iron. The serum ferritin would be low with iron deficiency anemia and high with liver disease or iron storage diseases.
D. Incorrect. This test is useful for hemoglobinopathies such as sickle cell anemia or thalassemia.

11. A 10-yr-old boy presents with high fever since 10 days. O/E- Petechial hemorrhages on trunk and extremities. CBC shows normal Hb, normal platelet count; leukopenia with absolute neutropenia. BM biopsy does not show any abnormal cells. Which of the following is the most likely diagnosis?

Viral infection

Overwhelming bacterial infection

Megaloblastic anemia

Allergic reactions

Parasitic infestation

B. Correct. Overwhelming infection causes increased peripheral use of neutrophils at sites of inflammation. Petechial hemorrahges can occur in infections like Neisseria meningitidis.

A. Incorrect. Viral infection shows lymphocytic leukocytosis.
C. Incorrect. Megaloblastic anemia would show pancytopenia (anemia, leukopenia, thrombocytopenia), megaloblasts in BM, macrocytes, macro-ovalocytes and hyper-segmented neutrophils.
D. Incorrect. Allergic reactions show eosinophilic leukocytosis.
E. Incorrect. Parasitic infestation shows eosinophilic leukocytosis.

Explanation

B. Correct. Overwhelming infection causes increased peripheral use of neutrophils at sites of inflammation. Petechial hemorrahges can occur in infections like Neisseria meningitidis.

A. Incorrect. Viral infection shows lymphocytic leukocytosis.
C. Incorrect. Megaloblastic anemia would show pancytopenia (anemia, leukopenia, thrombocytopenia), megaloblasts in BM, macrocytes, macro-ovalocytes and hyper-segmented neutrophils.
D. Incorrect. Allergic reactions show eosinophilic leukocytosis.
E. Incorrect. Parasitic infestation shows eosinophilic leukocytosis.

12. A 12-year-old girl presents with fever and a swollen lymph node of 6 days duration. Biopsy of the lymph node reveals benign follicular hyperplasia. The pathologic finding is interpreted as which of the following?

Proliferation in B-cell areas

Proliferation in T-cell areas

Proliferation of cancer cells

Proliferation of plasma cells

A Correct. Follicular hyperplasia refers to enlarged lymph follicles (mainly in the cortex of lymph node), which consists of B-lymphocytes. Reactive follicular hyperplasia of lymph nodes represents a response to infections, inflammation or tumors.
B Incorrect. Hyperplasia of the deep cortex or paracortex (interfollicular) is characteristic of T-cell immunoreactivity.
C Incorrect.
D Incorrect. Plasmacytosis occurs in medullary cords.

Explanation

A Correct. Follicular hyperplasia refers to enlarged lymph follicles (mainly in the cortex of lymph node), which consists of B-lymphocytes. Reactive follicular hyperplasia of lymph nodes represents a response to infections, inflammation or tumors.
B Incorrect. Hyperplasia of the deep cortex or paracortex (interfollicular) is characteristic of T-cell immunoreactivity.
C Incorrect.
D Incorrect. Plasmacytosis occurs in medullary cords.

13. A 40-year-old female is diagnosed with Crohn's disease. She does not respond to medication. She undergoes surgery (partial resection of colon and terminal ileum). Few weeks later, she presents with fatigue. CBC shows Hb-10 gm%, MCV-110 fL; Reticulocyte count is 0.4%. Which of the following is most likely responsible for her anemia?

Anemia of chronic disease

Iron deficiency anemia

Hemolytic anemia

Vitamin B12 deficiency

Bone marrow infiltration by a tumor

D. Correct. Absorption of vitamin B12 occurs in the terminal ileum. So, an ileal resection can result in a megaloblastic anemia. (MCV-110)
A, B- Both anemia of chronic disease and microcytic anemias have low MCV. Anemia of chronic disease can also be normocytic (Normal MCV)
C. In hemolytic anemia, reticulocyte count is usually elevated.
E. BM infiltration by a tumor results in an anemia with tear drop cells.

Explanation

D. Correct. Absorption of vitamin B12 occurs in the terminal ileum. So, an ileal resection can result in a megaloblastic anemia. (MCV-110)
A, B- Both anemia of chronic disease and microcytic anemias have low MCV. Anemia of chronic disease can also be normocytic (Normal MCV)
C. In hemolytic anemia, reticulocyte count is usually elevated.
E. BM infiltration by a tumor results in an anemia with tear drop cells.

14. Which of the following neoplasms is malignant?

Seminoma

Adenoma

Chondroma

Osteoma

Leiomyoma

A. Correct. Seminoma is a malignant tumor arising from germ cells in the testes.

B. Incorrect. Adenoma is a benign tumor arising from glands.
C. Incorrect. Chondroma is a benign tumor arising from chondrocytes.
D. Incorrect. Osteoma is a benign tumor arising from bone.
E. Incorrect. Leiomyoma is a benign tumor composed of smooth muscles.

Explanation

A. Correct. Seminoma is a malignant tumor arising from germ cells in the testes.

B. Incorrect. Adenoma is a benign tumor arising from glands.
C. Incorrect. Chondroma is a benign tumor arising from chondrocytes.
D. Incorrect. Osteoma is a benign tumor arising from bone.
E. Incorrect. Leiomyoma is a benign tumor composed of smooth muscles.

15. A 72-year-old man has been feeling tired for the past 8 months. O/E - No abnormal findings. Lab. studies show Hb 10.4 g/dL, Hct 30.3%, MCV 72 fL, platelet count 239,000/uL, WBC count 7500/uL with automated differential count of 70.1% granulocytes, 18.8% lymphocytes, and 11.1% monocytes. His total bilirubin is 1.0 mg/dL. Which of the following morphologic findings is most likely to be seen on his peripheral blood smear?

Fragmentation

Schistocytes

Howell-Jolly bodies

Microcytic hypochromic RBCs

Spherocytosis

(D) CORRECT. The most probable cause of a hypochromic, microcytic anemia in an older male is iron deficiency anemia.
A. Incorrect. Fragmented RBC's, called schistocytes, are indicative of a micro-angiopathic hemolytic anemia such as DIC. Serum bilirubin is usually elevated in hemolytic anemia.
B. Incorrect. Fragmented RBC's, called schistocytes, are indicative of a micro-angiopathic hemolytic anemia such as DIC. Serum bilirubin is usually elevated in hemolytic anemia.
C. Incorrect. H-J bodies suggest absence of a functioning spleen.
E. Incorrect. Hereditary spherocytosis is uncommon. With a normal bilirubin, hemolysis is probably not present.

Explanation

(D) CORRECT. The most probable cause of a hypochromic, microcytic anemia in an older male is iron deficiency anemia.
A. Incorrect. Fragmented RBC's, called schistocytes, are indicative of a micro-angiopathic hemolytic anemia such as DIC. Serum bilirubin is usually elevated in hemolytic anemia.
B. Incorrect. Fragmented RBC's, called schistocytes, are indicative of a micro-angiopathic hemolytic anemia such as DIC. Serum bilirubin is usually elevated in hemolytic anemia.
C. Incorrect. H-J bodies suggest absence of a functioning spleen.
E. Incorrect. Hereditary spherocytosis is uncommon. With a normal bilirubin, hemolysis is probably not present.

16. A 15-year-old boy has a positive monospot test. He has a mild pharyngitis followed by generalized lymphadenopathy, malaise, and mild scleral icterus. His spleen tip is also palpable. He recovers in a month. Which of the following is the most likely finding on the peripheral smear?

Lymphocytopenia

Atypical lymphocytes

Neutrophilia

Eosinophilia

B. Correct. The "atypical" lymphocytes are antigenically stimulated T lymphocytes with an increased amount of cytoplasm in persons with infectious mononucleosis from Epstein-Barr virus (EBV) infection.
Incorrect. Patients with infectious mononucleosis generally present with lymphocytosis (increase in lymphocyte count) and not lymphopenia (decrease in lymphocyte count).
C. Incorrect. Neutrophilia is a feature of acute bacterial infections. This patient is suffering from infectious mononucleosis, which is a viral infection.
D. Incorrect. Eosinophilia is seen in allergic reactions and parasitic infections.

Explanation

B. Correct. The "atypical" lymphocytes are antigenically stimulated T lymphocytes with an increased amount of cytoplasm in persons with infectious mononucleosis from Epstein-Barr virus (EBV) infection.
Incorrect. Patients with infectious mononucleosis generally present with lymphocytosis (increase in lymphocyte count) and not lymphopenia (decrease in lymphocyte count).
C. Incorrect. Neutrophilia is a feature of acute bacterial infections. This patient is suffering from infectious mononucleosis, which is a viral infection.
D. Incorrect. Eosinophilia is seen in allergic reactions and parasitic infections.

17. A 17-year-old adolescent has had malaise for past 3 wks. Physical examination shows mild pharyngitis and tender axillary/inguinal lymphadenopathy. CBC shows Hb 14.0 g/dL, Hct 42.2%, MCV 90 fL, platelets 301,300/µL, WBC count 8120/µL with "atypical lymphocytes" on peripheral blood smear. Monospot test is positive. What is most likely to be seen on a lymph node biopsy?

Follicular hyperplasia due to proliferation of B cells

Paracortical hyperplasia due to proliferation of activated T cells

Sinus hyperplasia of histiocytes

Necrotizing lymphadenitis

Granulomatous lymphadenitis

(B) Correct. Infectious mononucleosis is typically acquired with close personal contact.
Atypical lymphocytosis in a young person suggests infectious mononucleosis, which is an infection, as the likely etiology.

A Incorrect. This is more likely to be seen in conditions like rheumatoid arthritis.
C. Incorrect. This is more often seen in cancers draining lymph node.
D. Incorrect. This is a feature of cat-scratch disease.
E. Incorrect. This is a feature of tuberculosis.

Explanation

(B) Correct. Infectious mononucleosis is typically acquired with close personal contact.
Atypical lymphocytosis in a young person suggests infectious mononucleosis, which is an infection, as the likely etiology.

A Incorrect. This is more likely to be seen in conditions like rheumatoid arthritis.
C. Incorrect. This is more often seen in cancers draining lymph node.
D. Incorrect. This is a feature of cat-scratch disease.
E. Incorrect. This is a feature of tuberculosis.

18. A 30-year-old man gives a history of sore throat with fever followed by 6 weeks of malaise. O/E he has mildly tender generalized lymphadenopathy. A cervical lymph node biopsy shows a diffuse paracortical hyperplasia. Which of the following is the most likely diagnosis?

Lymphoma

Lymph node draining a cancer

Infectious mononucleosis

Acute lymphadenitis

C. Correct. This is a typical history for infectious mononucleosis. The peripheral blood usually demonstrates atypical lymphocytosis. Liver involvement may lead to mild icterus.

A Incorrect. A lymphoma is a malignant proliferation of lymphoid cells.
B Incorrect. A lymph node draining a cancer shows sinus hyperplasia.Acute lymphadenitisTuberculosis of the lymph node shows granulomatous inflammation.
D. Incorrect. Acute lymphadenitis shows presence of neutrophils on biopsy.

Explanation

C. Correct. This is a typical history for infectious mononucleosis. The peripheral blood usually demonstrates atypical lymphocytosis. Liver involvement may lead to mild icterus.

A Incorrect. A lymphoma is a malignant proliferation of lymphoid cells.
B Incorrect. A lymph node draining a cancer shows sinus hyperplasia.Acute lymphadenitisTuberculosis of the lymph node shows granulomatous inflammation.
D. Incorrect. Acute lymphadenitis shows presence of neutrophils on biopsy.

19. Histologic examination of a hamartoma would reveal

Ectopic islands of normal tissue

Disorganized normal tissue

Tumor with tissues derived from all 3 germ cell layers

Tumor originating from one germ cell layer, but having 2 morphological patterns.

Histologic examination of a hamartoma would reveal disorganized normal tissue. A hamartoma is a benign tumor-like growth that consists of an overgrowth of mature cells and tissues that are normally present in the area. Unlike a true neoplasm, a hamartoma does not exhibit uncontrolled growth or invasion into surrounding tissues. Instead, it is characterized by a disorganized arrangement of normal cells and tissues, often resembling the normal architecture of the organ in which it is found. Therefore, the correct answer is disorganized normal tissue.

Explanation

Histologic examination of a hamartoma would reveal disorganized normal tissue. A hamartoma is a benign tumor-like growth that consists of an overgrowth of mature cells and tissues that are normally present in the area. Unlike a true neoplasm, a hamartoma does not exhibit uncontrolled growth or invasion into surrounding tissues. Instead, it is characterized by a disorganized arrangement of normal cells and tissues, often resembling the normal architecture of the organ in which it is found. Therefore, the correct answer is disorganized normal tissue.

20. A 51-year-old man has become increasingly fatigued for the past 10 months. O/E- No abnormal findings. Labs- Hb 9.2gm%, Hct 27.9%, MCV 132 fL, platelets 242,000/µL, WBC count 7800/µL. Which morphologic finding is most likely to be present on his peripheral blood smear?

Hyper-segmented neutrophils

Normocytic RBCs

Hypochromasia

Microcytic RBC's

A. CORRECT. The MCV points to a macrocytic anemia such as a megaloblastic anemia that can have hypersegmented PMN's.
B. Incorrect. MCV is normal in normocytic anemia.
C. ,D Incorrect. Microcytic RBC's have a low MCV. Hypochromasia is a feature of iron deficiency anemia that is microcytic (low MCV)

Explanation

A. CORRECT. The MCV points to a macrocytic anemia such as a megaloblastic anemia that can have hypersegmented PMN's.
B. Incorrect. MCV is normal in normocytic anemia.
C. ,D Incorrect. Microcytic RBC's have a low MCV. Hypochromasia is a feature of iron deficiency anemia that is microcytic (low MCV)

21. A 63-year-old woman has had malaise and nausea for the past 14 months. Her stool is negative for occult blood. Upper GI endoscopy and other investigations reveal findings of a pernicious anemia . Her Hb is 7.9 g/dL. Which of the following laboratory findings is most likely to be present in this woman?

Decreased serum ferritin

Increased reticulocyte count

Decreased serum folate

Increased neutrophil segmentation

Decreased red cell MCV

(D) CORRECT. Atrophic gastritis can be followed by pernicious anemia. Megaloblastic changes lead to hypersegmented PMN's, as well as an increased MCV of RBC's.
(A) Incorrect. Decreased ferritin suggests decreased storage iron with iron deficiency. Iron is mainly absorbed in the small intestine
(B) Incorrect. The reticulocyte count is typically decreased with nutritional anemias.
(C) Incorrect. Folate is absorbed in the small intestine, though a deficiency of folate could lead to a megaloblastic anemia that mimics that of B12 deficiency.
(E) Incorrect. The MCV is increased in the megaloblastic anemia of B12 deficiency.

Explanation

(D) CORRECT. Atrophic gastritis can be followed by pernicious anemia. Megaloblastic changes lead to hypersegmented PMN's, as well as an increased MCV of RBC's.
(A) Incorrect. Decreased ferritin suggests decreased storage iron with iron deficiency. Iron is mainly absorbed in the small intestine
(B) Incorrect. The reticulocyte count is typically decreased with nutritional anemias.
(C) Incorrect. Folate is absorbed in the small intestine, though a deficiency of folate could lead to a megaloblastic anemia that mimics that of B12 deficiency.
(E) Incorrect. The MCV is increased in the megaloblastic anemia of B12 deficiency.

22. A 40-yr-old woman presents with chronic fatigue. Labs show a microcytic hypochromic anemia. Endoscopy shows a bleeding peptic ulcer measuring 1 cm in diameter. Which of the following best describes the pathogenesis of anemia in this patient?

Defective globin chain synthesis

Impaired heme synthesis

Poor utilization of iron stores

Synthesis of structurally abnormal hemoglobin

B. Correct. Anemia due to chronic blood loss is iron deficiency, which is microcytic hypochromic.
A. Incorrect. Defective globin synthesis would result in thalassemia
C. Incorrect. Poor utilization of iron stores is seen in anemia of chronic disease.
D. Incorrect. Synthesis of structurally abnormal Hb refers to hemoglobinopathies like thalassemia or sickle cell anemia.

Explanation

B. Correct. Anemia due to chronic blood loss is iron deficiency, which is microcytic hypochromic.
A. Incorrect. Defective globin synthesis would result in thalassemia
C. Incorrect. Poor utilization of iron stores is seen in anemia of chronic disease.
D. Incorrect. Synthesis of structurally abnormal Hb refers to hemoglobinopathies like thalassemia or sickle cell anemia.