FRCPath Haem Part 1 EMQs-Morphology 511

For each of the following clinical scenarios, select the most likely expected bone marrow trephine morphological finding from the list of options.

Each option may be used once, more than once, or not at all.

Option	Expected bone marrow trephine finding
A	Multifocal dense aggregates of spindle-shaped mast cells
B	Increased atypical megakaryocytes, with bulbous cloud-like nuclei, accompanied by reticulin and collagen fibrosis
C	Interstitial infiltration by lymphoid cells with abundant pale cytoplasm, with increased reticulin
D	Paratrabecular lymphoid aggregates
E	Intertrabecular infiltration by small lymphocytes, plasmacytoid lymphocytes and plasma cells
F	Diffuse infiltration by small mature lymphocytes
G	Nodular and diffuse infiltration by small B lymphocytes with irregular nuclear contours
H	Diffuse infiltration by plasma cells with eccentric nuclei and perinuclear hof

Questions

Question 1

A 55-year-old man presents with recurrent episodes of flushing, pruritus, diarrhoea and unexplained osteoporosis.

What is the expected bone marrow trephine finding?

Question 2

A 69-year-old man presents with progressive anaemia, splenomegaly, constitutional symptoms and a leucoerythroblastic blood film. Molecular testing identifies a JAK2 V617F mutation.

What is the expected bone marrow trephine finding?

Question 3

A 63-year-old man presents with pancytopenia, recurrent infections and massive splenomegaly. Bone marrow aspiration results in a dry tap. Flow cytometry demonstrates a clonal B-cell population .

What is the expected bone marrow trephine finding?

Question 4

A 58-year-old woman presents with generalised lymphadenopathy. Lymph node biopsy confirms IGH::BCL2 rearrangement.

What is the expected bone marrow trephine finding?

Question 5

A 72-year-old man presents with anaemia, an IgM paraprotein and symptoms of hyperviscosity.

What is the expected bone marrow trephine finding?