Snapshot A 15-year-old boy presents with fatigue and masses around his neck. The masses are small, mobile, and do not hurt. A few months ago, he had had an episode of infectious mononucleosis. He is referred for a lymph node biopsy, which comes back with positive Reed-Sternberg cells. Introduction B-cell malignancy originating in lymphatic system Pathogenesis 50% of cases associated with EBV infection Reed-Sternberg cells CD15+ and CD30+ Epidemiology bimodal distribution young adulthood > 55 years male > female Types of Hodgkin lymphoma nodular sclerosing most common mixed cellularity lymphocyte-rich & predominant especially in < 35-year-olds but also in older adults lymphocyte-depleted especially in > 60-year-olds other systemic diseases Risk factors infectious mononucleosis with EBV Presentation Symptoms constitutional ("B") symptoms fever night sweats weight loss all caused by cytokines released from Reed-Sternberg cells persistent painless lymphadenopathy Physical exam nontender mass of localized, single group of nodes rubbery mobile cervical supraclavicular axillary Evaluation Imaging for staging Lymph node biopsy Reed-Sternberg cells binucleate or bilobed, “owl-eyed” nuclei mixed cellularity type large inflammatory infiltrate with many eosinophils nodular sclerosing type diffuse band-like fibrosis with lacunar spaces Differential Diagnosis Non-Hodgkin lymphoma AIDS-related lymphadenopathy Infection Breast cancer Cat-scratch fever Treatment Based on staging Chemotherapy Radiation Prognosis, Prevention, and Complications Prognosis > 80% with treatment better than non-Hodgkin lymphoma lymphocyte-predominant = best prognosis lymphocyte-deplete = worst prognosis higher lymphocyte:RS cell ratio = better prognosis Complications SVC syndrome paraneoplastic syndromes calctriol secretion causes hypercalcemia from treatment risk of solid tumors (breast, thyroid, and lung) risk of premature coronary artery disease risk of infection
QUESTIONS 1 of 2 1 2 Previous Next (M1.ON.17.4753) A 52-year-old female presents to her primary care physician complaining of fever, chills, and night sweats. She says that these symptoms have been present for several months but appear to be getting worse. Her past medical history is significant for mild hypertension and pre-diabetes. She has otherwise been healthy and does not currently take any medications. Physical examination reveals supraclavicular lymphadenopathy. A lymph node biopsy is performed and the result is shown in Figure A. Which of the following cell surface markers is most likely found on the prominent abnormal cell seen in the figure? Tested Concept QID: 108772 FIGURES: A Type & Select Correct Answer 1 CD3 8% (9/119) 2 CD4 12% (14/119) 3 CD8 17% (20/119) 4 CD16 17% (20/119) 5 CD30 45% (54/119) M 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review tested concept (M1.ON.13.6) A 28-year-old male presents to his primary care physician complaining of fever, chills, night sweats, and a "lump" in the middle portion of his neck. A biopsy of the cervical protuberance is taken and shown in Figure A. The large cell shown in the center of Figure A is likely of which of the following origins? Tested Concept QID: 101316 FIGURES: A Type & Select Correct Answer 1 B-cell 72% (61/85) 2 T-cell 7% (6/85) 3 Basophil 2% (2/85) 4 Metamyelocyte 4% (3/85) 5 Monocyte 14% (12/85) M 2 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review tested concept