FRCPath Haem Part 1 MCQs-Oncology 472

A 64-year-old man presents with a 3-month history of progressive fatigue, night sweats and weight loss of 9 kg. Examination reveals generalized lymphadenopathy and moderate splenomegaly.

FBC:

Parameter	Result
Hb	96 g/L
WBC	58 × 10⁹/L
Neutrophils	8.2 × 10⁹/L
Lymphocytes	46 × 10⁹/L
Platelets	112 × 10⁹/L

The cells are medium-to-large, with a relatively high nuclear-to-cytoplasmic ratio. Nuclei are irregular and occasionally cleaved. The chromatin is moderately condensed but some cells have dispersed chromatin. A proportion of the cells have blastoid morphology, with round nuclei, fine chromatin and inconspicuous nucleoli. Bone marrow aspirate demonstrates extensive infiltration by the abnormal lymphoid population.

Flow cytometry demonstrates a mature B-cell population:

• CD19: positive

• CD20: strong

• CD22: positive

• Light-chain restricted

• CD5: positive

• CD10: negative

• FMC7: positive

Which of the following is the most likely additional immunophenotype?

A. CD10+, BCL6+, BCL2+, cyclin D1−

B. Cyclin D1+, SOX11+, BCL6−, CD10−

C. CD23+, LEF1+, cyclin D1−, SOX11−

D. CD10+, BCL6+, MUM1+, cyclin D1+

E. CD138+, MUM1+, CD20−, PAX5−