PA H8 | Lymphadenopathy & Lymphomas — Practice Quiz

A 22-year-old student presents with a 3-week history of bilateral posterior cervical lymphadenopathy. The nodes are soft, tender, and measure 1.5 cm. He has fever, sore throat, and fatigue. Peripheral blood smear shows atypical lymphocytes. Which of the following is the most appropriate initial diagnostic step?

A 45-year-old woman is referred with a 2 cm, firm, non-tender left axillary lymph node of 6 weeks duration. She has no fever or weight loss. Ultrasound shows a round node with loss of fatty hilum. What is the most appropriate next investigation?

Histology of a reactive lymph node shows enlarged follicles with prominent germinal centres containing tingible-body macrophages, a well-defined mantle zone, and a mixed population of centroblasts and centrocytes. The interfollicular areas appear normal. Which type of reactive hyperplasia pattern is this?

A 30-year-old male presents with cervical lymphadenopathy, low-grade fever, and night sweats for 8 weeks. FNAC reveals epithelioid granulomas with central caseous necrosis and occasional Langhans-type giant cells. Ziehl-Neelsen stain shows acid-fast bacilli. Which of the following best describes the gross appearance of the involved node at surgery?

A histopathology report describes a lymph node with non-caseating epithelioid granulomas, no central necrosis, no acid-fast bacilli on ZN stain, and negative cultures. Serum ACE is elevated. The most likely diagnosis is:

On histology of a Hodgkin lymphoma lymph node biopsy, large binucleated cells with prominent 'owl-eye' nucleoli are seen in a background of lymphocytes, eosinophils, plasma cells, and neutrophils. Immunohistochemistry shows CD15+ and CD30+ on these cells. CD20 and CD3 are negative. What is the cell type identified?

A 28-year-old woman is diagnosed with classical Hodgkin lymphoma, nodular sclerosis subtype. Staging reveals involvement of the right cervical and mediastinal lymph nodes. If disease progresses untreated, to which site would lymphoma most characteristically spread next, according to its pattern of dissemination?

Biopsy of a large mediastinal mass in a 20-year-old woman shows bands of collagen dividing the nodal tissue into cellular nodules. Lacunar cells are identified within these nodules, alongside lymphocytes and eosinophils. CD30 and CD15 immunostains are positive on the large cells. What is the subtype of Hodgkin lymphoma?

EBV is most strongly associated with which subtype of classical Hodgkin lymphoma?

A 55-year-old man presents with painless generalised lymphadenopathy and hepatosplenomegaly for 6 months. Lymph node biopsy shows effacement of nodal architecture by follicle-like structures composed predominantly of small cleaved lymphocytes (centrocytes) with occasional large cells. Immunohistochemistry: CD20+, BCL2+, CD10+, BCL6+, CD5−. Cytogenetics shows t(14;18). What is the diagnosis?

A 65-year-old woman presents with a rapidly enlarging abdominal mass of 6 weeks duration, constitutional B-symptoms, and elevated LDH. Biopsy shows large cells with vesicular nuclei, prominent nucleoli, and abundant cytoplasm effacing the nodal architecture in a diffuse pattern. IHC: CD20+, BCL6+, MUM1+. What is the most likely diagnosis?

A 10-year-old boy in sub-Saharan Africa presents with a rapidly enlarging jaw mass. Biopsy shows intermediate-sized lymphoid cells with round nuclei, multiple small nucleoli, and a high mitotic rate. A 'starry-sky' pattern is noted due to scattered macrophages engulfing apoptotic debris. Ki-67 approaches 100%. EBER in situ hybridisation is positive. Which chromosomal translocation is most characteristic of this tumour?

A 42-year-old man presents with fever, drenching night sweats, unexplained weight loss >10% body weight, and non-tender left cervical lymphadenopathy. A 32-year-old woman in the same clinic has bilateral painless inguinal lymphadenopathy, no constitutional symptoms, and a slow-growing mass over 18 months. Which clinical distinction most helps differentiate Hodgkin from Non-Hodgkin lymphoma in these presentations?

A 17-year-old boy presents with fever, right-sided jaw swelling, and abdominal distension over 3 weeks. CT scan shows a jaw mass and retroperitoneal lymphadenopathy. LDH is 5 times the upper limit of normal. Biopsy of the jaw mass reveals intermediate-sized monomorphic lymphoid cells with scanty cytoplasm, round nuclei with multiple nucleoli, and a starry-sky pattern. Ki-67 is 99%. FISH confirms t(8;14). Serum uric acid is markedly elevated. Which statement best describes the pathogenesis of the starry-sky pattern in this tumour?