Review Question - QID 109598

A 45-year-old African American female presents to her primary care physician complaining of fatigue. She reports a six-month history of gradually worsening malaise, cough, weight loss, and pain in her legs and ankles. Her past medical history is significant for diabetes. She takes metformin and glyburide. She drinks socially and has a 10 pack-year smoking history. Physical examination reveals lymphadenopathy, hepatoplenomegaly, and plaques overlying the patient’s chest and upper extremities. A lymph node biopsy is performed and results are shown in Figure A. The process shown is maintained by which of the following?