Haematology: adult T-cell leukaemia/lymphoma: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Haematology: adult T-cell leukaemia/lymphoma

Sample item

A 45-year-old man from an area of southwestern Japan has skin lesions, hypercalcaemia and lytic bone lesions. His smear shows lymphocytes with multilobated, clover-leaf nuclei. The neoplastic cells are CD4 positive. Which diagnosis fits best?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Adult T-cell leukaemia/lymphoma

Adult T-cell leukaemia/lymphoma is caused by the retrovirus HTLV-1, endemic in southwestern Japan and the Caribbean. Flower cells, skin involvement, hypercalcaemia with lytic bone lesions and a CD4 phenotype are typical.

Option by option

  • A. Adult T-cell leukaemia/lymphoma (correct)

    Correct. The geographic setting, flower cells, hypercalcaemia and CD4 phenotype indicate HTLV-1 related disease.

  • B. Sezary syndrome

    Sezary syndrome has cerebriform cells with erythroderma and is not tied to HTLV-1 or to hypercalcaemia with lytic lesions.

  • C. Hairy cell leukaemia

    Hairy cell leukaemia is a B-cell neoplasm with cytoplasmic projections, splenomegaly and pancytopenia.

  • D. Mycosis fungoides

    Mycosis fungoides has cerebriform cells confined mostly to the skin and lacks this systemic picture.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Pathology questions

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is A, Adult T-cell leukaemia/lymphoma. Adult T-cell leukaemia/lymphoma is caused by the retrovirus HTLV-1, endemic in southwestern Japan and the Caribbean.

Why is "Sezary syndrome" not the answer?

Sezary syndrome has cerebriform cells with erythroderma and is not tied to HTLV-1 or to hypercalcaemia with lytic lesions.

Why is "Hairy cell leukaemia" not the answer?

Hairy cell leukaemia is a B-cell neoplasm with cytoplasmic projections, splenomegaly and pancytopenia.

Why is "Mycosis fungoides" not the answer?

Mycosis fungoides has cerebriform cells confined mostly to the skin and lacks this systemic picture.

What concept does this question test?

It tests Haematology: adult T-cell leukaemia/lymphoma in Pathology. Flower cells, skin involvement, hypercalcaemia with lytic bone lesions and a CD4 phenotype are typical.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Haematology: adult T-cell leukaemia/lymphoma?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.