With regard to clonal hematopoiesis of indeterminate potential (CHIP, also known as age-related clonal hematopoiesis), which one of the following statements is WRONG?
(A) The condition may exist in up to 10% of persons over the age of 70 years.
(B) Odds of progression to overt neoplasia are approximately 0.5 – 1% per year.
(C) Marrow study in individuals with CHIP often shows features of mild dysplasia.
(D) The designation of CHIP represents the presence of a somatic mutation associated with hematological neoplasia at a variant allele frequency of at least 2%.
(E) CHIP contributes causally to atherosclerotic cardiovascular disease.
Which of the following statements for myelodysplastic syndrome (MDS) is WRONG according to WHO 2016 criteria?
(A) The lineage(s) manifesting significant morphologic dysplasia frequently do not correlate with the specific cytopenia(s) in individual MDS cases.
(B) The most frequent commonly mutated genes in MDS are SF3B1, TET2, SRSF2, ASXL1, DNMT3A, RUNX1, U2AF1, TP53, and EZH2
(C) The spliceosome gene SF3B1 mutations are frequently found in MDS with ring sideroblasts (MDS-RS).
(D) Some data demonstrated that the presence of TET2 mutations may be associated with response to azacitidine therapy.
(E) To separate MDS from reactive causes of cytopenia and dysplasia is a big challenge. So, possible reactive etiologies of dysplasia should always be carefully considered prior to making a diagnosis of MDS, particularly when the dysplasia is subtle and limited to one lineage.
A 67-year-old patient visited your clinic with the complaint of dyspnea on exertion of 3-month duration. Laboratories revealed a hematocrit of 18%, hemoglobin 5.7 gm/dL (MCV 106fL), platelets of 180,000/mm3, leukocyte count of 1,500/mm3. The differential counts of white cells were as follows: Neutrophils 21.5%, Lymphocytes 58%, Monocytes 10%, Myeloblasts 2.5%, Myelocytes 3%, Metamyelocytes 1%, Band 4%. Bone marrow smear showed apparent dysplasia over myeloid and erythroid lineages. The marrow blast number was 3.5%, and there were no Auer rods. No ringed-sideroblasts were identified on iron stain. Based on the WHO 2016 classification of myeloid neoplasms, the diagnosis should be:
(A) MDS with single lineage dysplasia
(B) MDS with multilineage dysplasia
(C) MDS – EB-1 (excess blast) BM 5-9%, PB 2-5%
(D) MDS – EB-2