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  #1  
Old 10-01-2011
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Microscope Abdominal mass with a Wright and H&E Stains

A 49-year-old patient from California presented to the hospital because of nausea-vomiting, lack of appetite, and weight loss and abdominal pain since 3 weeks ago, which was localized in the right-lower quadrant, and it was relievable by defecation. During the past month, he had started to suffer diarrhea with no mucus and occasional appearance of fresh blood in the stool 2-3 times a day along with vomiting 1-2 times a day. Abdominal physical examination revealed a mass lesion of 22 14 cm in size with an upper border 3cm above the umbilicus and a lower border extending to the suprapubic region which was solid, deep, and painful upon palpation. CBC results were as follows: WBC: 8400/μL; lymphocyte: 1800/μL; Hb: 10.20 g/dL; MCV: 84.1L; platelet: 527000/mm3. Sedimentation rate was 60 mm/h, and CRP was 50 mg/L. There was no occult blood or parasite in the stool. Fecal culture showed no pathogenic bacterial growth. Because overall health status of the patient began to deteriorate progressively, he was transferred to surgery department for laparotomy. During the laparotomy, a tumoral lesion of approximately 20 cm in size was encountered in the ileum and resected. Histopathologic analysis of the resected material showed many cells positive for CD10, CD22, and bcl6.

The Wright staining histology is shown below:

Abdominal mass with a Wright and H&E Stains-wright-stain.jpg
click image to enlarge

H&E staining is also shown in the following picture:

Abdominal mass with a Wright and H&E Stains-h-e-stain.jpg
click image to enlarge

If this condition is associated with a cytogenetic change, which of the following genetic events is more probable?

A) t(11;14) and bcl-1 overexpression
B) t(8;14) and c-myc overexpression
C) t(9,22) and abl-bcr fusion
D) t(15,17) and RAR-alpha overexpression
E) t(14,18) and bcl-2 overexpression
F) t(11,12) and FLI1 overexpression
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Old 10-01-2011
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t(8;14) and c-myc overexpression
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Old 10-01-2011
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If this condition is associated with a cytogenetic change, which of the following genetic events is more probable?

A) t(11;14) and bcl-1 overexpression
B) t(8;14) and c-myc overexpression
C) t(9,22) and abl-bcr fusion
D) t(15,17) and RAR-alpha overexpression
E) t(14,18) and bcl-2 overexpression
F) t(11,12) and FLI1 overexpression

Burkitts lymphoma with starry sky appearance
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Old 10-01-2011
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Yes its Burkitt lymphoma, sporadic type most likely.

But if question likes this start coming in exam i will drown myself in Johny Walker
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Old 10-02-2011
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Where is this question from? I think this belongs to pathology board exam, not USMLE. But thanks anyway
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Old 10-02-2011
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B) t(8;14) and c-myc overexpression
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Old 10-02-2011
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i think it is B
but im still waiting for the explanation
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Old 10-03-2011
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"Starry-sky" appearance B

by the way, these images are on Wiki
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The tumor cells in Burkitt lymphoma generally strongly express markers of B cell differentiation (CD20, CD22, CD19) as well as CD10, and BCL6. The tumour cells are generally negative for BCL2 and TdT. The high mitotic activity of Burkitt lymphoma is confirmed by nearly 100% of the cells staining positive for Ki67
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B) t(8;14) and c-myc overexpression
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Old 02-01-2014
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OMgosh such an intimidating question, answer was so simple if you think it thru, giving you abdominal mass (mesentery tumor)most likely you will think of burkitts when you see translocations all over and also with the starry sky!!
all the lab values mess with your head... i guess this is my welcome to usmle real questions like.
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