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Difficulty: MediumPediatric Hematology and Oncology

A pediatric pathology team is correlating characteristic genetic and microscopic findings with their corresponding childhood malignancies. Match each specific diagnostic description with the most likely pediatric hematologic or oncologic diagnosis.

  • Lymph node biopsy revealing a 'starry-sky' pattern and a t(8;14) chromosomal translocationBurkitt lymphoma
  • Bone marrow aspirate demonstrating TdT-positive blasts that strongly express CD10 and CD19B-cell acute lymphoblastic leukemia (B-ALL)
  • Adrenal mass biopsy showing Homer-Wright rosettes with significant N-myc gene amplificationNeuroblastoma
  • Diaphyseal bone biopsy revealing uniform small round blue cells with a t(11;22) translocationEwing sarcoma

Answer

Burkitt lymphoma matches with t(8;14) and 'starry-sky' pattern; B-ALL matches with TdT, CD10, and CD19 positivity; Neuroblastoma matches with adrenal mass, Homer-Wright rosettes, and N-myc amplification; Ewing sarcoma matches with diaphyseal bone lesion and t(11;22).
Each pediatric malignancy has classic defining features that guide diagnosis. Burkitt lymphoma is defined by t(8;14) and 'starry-sky' macrophages; B-ALL by TdT and CD10/19 positivity; Neuroblastoma by N-myc amplification in sympathetic tissues; and Ewing sarcoma by t(11;22) in bone diaphyses.

Step-by-Step Solution

1
Analyze the first diagnostic description: 'starry-sky' pattern and t(8;14).
This correlates with Burkitt lymphoma.
t(8;14) translocates the c-myc oncogene to the Ig heavy chain locus, driving the hyperproliferation seen in Burkitt lymphoma.
2
Analyze the second diagnostic description: TdT-positive blasts expressing CD10 and CD19.
This correlates with B-cell acute lymphoblastic leukemia.
TdT is a marker for immature lymphoblasts, while CD10 and CD19 are specific to the B-cell lineage.
3
Analyze the third diagnostic description: Adrenal mass with Homer-Wright rosettes and N-myc amplification.
This correlates with Neuroblastoma.
Neuroblastomas are neural crest-derived tumors that often arise in the adrenal medulla and are prognostically stratified by N-myc amplification.
4
Analyze the fourth diagnostic description: Diaphyseal bone biopsy with small round blue cells and t(11;22).
This correlates with Ewing sarcoma.
The t(11;22) translocation is the defining molecular alteration of Ewing sarcoma, which classically affects the diaphysis of long bones.

Key Concept

Correlation of molecular genetics and histologic findings with pediatric malignancies
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Topics

Pediatric Hematology and Oncology

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