中華民國血液病學會

1. Which statement is false?

A. A histological biopsy of the cerebrum or meninges demonstrating a LPL is the golden standard for the diagnosis of BNS, and Biopsy should be attempted prior to steroid administration.

B. The Neurological deficits concerning Bing Neel syndrome: headaches, seizures, cranial nerve palsies,weakness in limbs, or atypical neuropathy.

C. Image finding (PET/CT or MRI) of the brain and spinal cord is essential for the diagnosis of CNS lymphomas.

D. Lumbar puncture for cerebrospinal fluid (CSF) analysis is not essential workup for BNS.

2. Which statement is false?
- The patient was a 75-year-old male, who had history of gastrointestinal bleeding related to gastric ulcer ten years ago. Laboratory data obtained at that time at Hospital revealed mild anemia (hemoglobin [Hb] 7.4 g/dL), normal white blood cell (WBC) count (5800/uL) and mild thrombocytopenia (platelet count 13.3*103/uL), but no further evaluation for the thrombocytopenia had been done.
- The patient experienced general malaise for a few months and weight loss within three months before this episode; dizziness on a chronic basis with no vertigo and blurred vision for several years presumed to result from cataract were also mentioned.
- The patient was found loss of consciousness on the road and admitted to the emergency department at hospital. Brain computed tomography (CT) reported no specific finding, but significant anemia (Hb 5.7 g/dL) and marked splenomegaly were found.
- Combining results of peripheral blood (PB) smear, bone marrow biopsy and serum immunofixation electrophoresis, hyperviscosity syndrome due to IgM monoclonal gammopathy was suspected.

A. Sensory symptoms including paresthesias, pins and needles sensations, and pain may represent in BNS.

B. Based on the information forementioned BNS could be confirmed.

C. Confirmation of HVS with appropriately increased IgM or serum viscosity measurements can aid in differentiating HVS related CNS symptoms from BNS.

D. he HVS consists of headache and vestibular symptoms, confusion, and a decreased level of consciousness

3. Which statement is false?

A. According to NCCN guidelines zanubrutinib and ibrutinib are preferred regimens for symptomatic BN.

B. Treatment should be offered to symptomatic patients in whom a definitive diagnosis of BNS has been established.

C. The role of autologous stem cell transplantation (ASCT) is clear and can be considered in young patients with aggressive disease behavior.

D. RT may be considered in BNS patients with localized spinal involvement in whom toxicity can be limited.