Lymphadenopathy/Random
Hard, fixed lymph nodes—especially in older patients and smokers—most strongly suggest this diagnosis.
what is metastatic cancer
Patients with this viral infection have increased Hodgkin lymphona risk?
EBV
This lymphoma is associated with HTLV-1 infection.
What is adult T-cell Leukemia/lymphoma
This diagnostic method has a high false-negative rate in lymphoma due to sampling error and difficulty recognizing well-differentiated lymphomas
What is fine needle aspiration (FNA)
A 29-year-old man comes to the physician because of a 3-month history of fatigue, weight loss, and multiple painless swellings on his neck and axilla. He reports that his swellings become painful after he drinks alcohol. Physical examination shows nontender cervical and axillary lymphadenopathy. A lymph node biopsy specimen shows giant binucleate cells. Which of the following is the most likely diagnosis?
Hodgkin Lymphoma
An 11-year-old boy who recently emigrated from Nigeria is brought to the physician for evaluation of jaw swelling. He has no history of serious illness and takes no medications. Examination shows a 5-cm solid mass located above the right mandible and significant cervical lymphadenopathy. A biopsy specimen of the mass shows sheets of lymphocytes with interspersed tingible body macrophages. Serology for Epstein-Barr virus is positive. Which of the following chromosomal translocations is most likely present in cells obtained from the tissue mass?
t(8;14)
This microscopic pattern of chronic lymphadenitis involves marked expansion of lymph node sinuses by macrophages and can occur in smokers, tattoo reactions, or in nodes draining cancers.
What is sinus histiocytosis?
This cytokine produced by RS cells is implicated in Hodgkin lymphoma-associated eosinophilia.
What us IL-5
A 62-year-old man comes to the physician because of a 2-month history of an itchy rash and a 7-kg (15-lb) weight loss. Physical examination shows multiple erythematous plaques on the arms, legs, and chest. There are palpable lymph nodes in the axillary and inguinal areas. A biopsy of a skin lesion shows aggregates of neoplastic cells within the epidermis. A peripheral blood smear is most likely to show which of the following findings in this patient?
A. CD4+ cells with cerebriform nuclei
B. Erythrocytes with basophilic nuclear remnants
C. Myeloblasts with azurophilic granules
D. Giant cells with bilobed nuclei
A. CD4+ cells with cerebriform nuclei
A 16-year-old boy is brought to the physician because of a lesion that has been growing on his jaw over the past several months. He recently immigrated to the USA from Kenya with his family. Physical examination shows a 3-cm solid mass located above the left mandible. There is cervical lymphadenopathy. Biopsy of the mass shows sheets of lymphocytes and interspersed reactive histiocytes with abundant, clear cytoplasm and phagocytosed debris. Which of the following mechanisms is most likely directly responsible for the malignant transformation of this patient's cells?
A. Defect in DNA Repair
B. Activation of Transcription
C. Integration of viral DNA
D. Inhibition of apoptosis
B. Activation of transcription
A 19-year-old man comes to the physician for evaluation of night sweats, pruritus, and enlarging masses in his right axilla and supraclavicular area for 2 weeks. Physical examination shows painless, rubbery lymphadenopathy in the right axillary, supraclavicular, and submental regions. An excisional biopsy of an axillary node is performed. If present, which of the following features would be most concerning for a neoplastic process?
A. Polyclonal proliferation of lymphocytes with a single nucleus
B. Abundant lymphocytes in a wide range of sizes and shapes in medullary cords
C. Preponderance of lymphocytes with a single immunoglobulin variable domain allele
D. Diffuse mitotic activity in secondary follicles
E. Predominance of histiocytes in the medullary sinuses
C. Preponderance of lymphocytes with a single immunoglobulin variable domain allele
A 48-year-old woman comes to the physician because of a 3-month history of low-grade fever, unintentional weight loss, night sweats, and a right-sided neck mass. Examination shows pallor. There is a non-tender and immobile right-sided cervical mass and enlarged axillary and inguinal lymph nodes. The liver is palpated 4 cm below the right costal margin, and the spleen is palpated 3 cm below the left costal margin. Histopathologic examination of a cervical lymph node biopsy specimen shows a nodular proliferation of centrocytes and centroblasts that stain positive for CD20. Genetic analysis shows a reciprocal translocation of chromosomes 14 and 18. This patient's condition is most likely caused by mutation of an oncogene that encodes for a protein involved in which of the following cellular processes?
Bcl-2: Inhibition of Programmed Cell Death
A biopsy showing Reed–Sternberg cells within a sea of neutrophils, eosinophils, and histiocytes most likely corresponds to this subtype.
What is mixed cellularity classic Hodgkin lymphoma?
A 55-year-old man comes to the physician because of a 3-month history of a progressively growing mass in his axilla. During this period, he has had night sweats, recurrent episodes of low-grade fever lasting for 7 to 10 days, and an 8-kg (18-lb) weight loss. His only medication is a multivitamin. Physical examination shows nontender, right axillary, cervical, and inguinal lymphadenopathy. His serum calcium concentration is 15.1 mg/dL and parathyroid hormone (PTH) concentration is 2 pg/mL. A lymph node biopsy shows granuloma formation and large CD15-positive, CD30-positive cells with bilobed nuclei. Which of the following is the most likely explanation for this patient's laboratory findings?
A. Excessive intake of dietary ergocalciferol
B. Increased release of PTH by parathyroid chief cells
C. Induction of focal osteolysis by tumor cells
D. Secretion of γ-interferon by activated T-lymphocytes
D. Secretion of γ-interferon by activated T-lymphocytes
A 60-year-old man comes to the physician because of persistent fatigue over the past ten months. His previous annual health maintenance examination showed no abnormalities. He appears pale. Physical examination shows numerous petechial lesions over the abdomen and marked splenomegaly. His hemoglobin concentration is 9.4 g/dL, leukocyte count is 4,100/mm3, and thrombocyte count is 110,000/mm3. A peripheral blood smear shows large white blood cells with centrally placed nuclei and multiple fine, radial cytoplasmic projections that stain positively for tartrate-resistant acid phosphatase. What is the medication used to treat this and its MOA?
Cladribine
Purine analog that mimics adenosine, thus inhibiting nucleotide metabolism.
(Pentostatin is another purine analog that is also used in the treatment of hairy cell leukemia and acts by inhibiting adenosine deaminase.)