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Review Question - QID 101316

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QID 101316 (Type "101316" in App Search)
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?
  • A

B-cell

84%

234/278

T-cell

5%

13/278

Basophil

2%

5/278

Metamyelocyte

3%

8/278

Monocyte

6%

17/278

  • A

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This patient's constitutional symptoms of fever, night sweats, and chills, along with the presence of a neck mass, is consistent with Hodgkin lymphoma. The histologic image shows a Reed-Sternberg cell, which is a CD30+ and CD15+ cell of B-cell origin.

Reed-Sternberg cells are large and bi- or multi-nucleate with prominent "owl-eyed" nucleoli that are usually negative for CD20+ and CD45+. The presence of Reed-Sternberg cells is necessary but not sufficient for a diagnosis of Hodgkin lymphoma. Hodgkin lymphoma has a bimodal age distribution, with one peak in the second or third decade of life and a second in the fifth decade. Complete blood count and peripheral blood smears are generally unremarkable in Hodgkin lymphoma patients.

Glass reviews the symptomatology of Hodgkin lymphoma. Painless lymphadenopathy involving cervical, supraclavicular, or axillary nodes is one of the most common symptoms. One-third of patients with Hodgkin lymphoma present with "B symptoms" - unexplained fever, night sweats, and recent weight loss.

Yurchenko et al. review surface cell markers in Hodgkin lymphoma. Mononucleated Hodgkin cells and multinucleated Reed-Sternberg (HRS) cells, which usually account for only about 1% of cells in the tumor tissue, are characteristic for Hodgkin lymphoma. The majority of HRS cells in Hodgkin lymphoma are derived from germinal center B cells.

Figure A shows a Reed-Sternberg cell, a finding necessary for the diagnosis of Hodgkin lymphoma. Illustration A summarizes the "Ann Arbor" classification system for staging Hodgkin lymphoma.

Incorrect answers:
Answers 2-5: These are not cell lineages that develop into Reed Sternberg cells.

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