Question 122
During a yearly physical examination of a 19-year-old male, a family physician palpates cervical lymph nodes. One of the enlarged lymph nodes is biopsied. Large cells within the lymph node express CD15 and CD30. Of the following, what is the most likely diagnosis?
A. Burkitt lymphoma
B. Follicular lymphoma
C. Diffuse large B cell lymphoma
D. Lymphocyte predominant Hodgkin disease
E. Classical Hodgkin lymphoma
Answer for Question 122
Answer: E (Classical Hodgkin lymphoma)
Explanation: The CD15 and CD30 positivity are characteristic of classical Hodgkin lymphoma. Burkitt lymphoma, follicular lymphoma, and diffuse large B cell lymphoma are B cell neoplasms and do not normally express CD15 and CD30. Lymphocyte predominant Hodgkin disease does often present as cervical lymphadenopathy; however, the neoplastic cells are CD20 positive and do not normally express CD15 and CD30.
Question 123
A 55-year-old male presents to his family physician complaining of intermittent fevers and night sweats over the past 6 months. He also notes a 20 lb. weight loss in the same time frame. Physical examination reveals an enlarged spleen. A chest x-ray reveals enlarged mediastinal lymph nodes. Biopsy of a lymph node reveals large cells, some with bilobed nuclei and prominent nucleoli, surrounded by an infiltrate of lymphocytes, eosinophils, plasma cells, and macrophages. Of the following viruses, which one is most likely to be associated with his condition?
A. HTLV
B. Hepatitis B
C. CMV
D. Parvovirus
E. EBV
Answer for Question 123
Answer: E (EBV)
Explanation: The histologic findings are consistent with mixed cellularity Hodgkin disease, with the large cells with bilobed nuclei and prominent nucleoli being Reed-Sternberg cells. Mixed cellularity is the form of Hodgkin disease that is more common in older males, and can present with systemic symptoms, such as fevers, night sweats, and weight loss. Of the viruses listed, EBV is the one most commonly associated with Hodgkin disease (70% of cases of mixed cellularity), and most likely plays a role in the development of the neoplasm.
Question 124
A 53-year-old female with a history of Hashimoto’s thyroiditis diagnosed 10 years ago and treated with thyroid hormone replacement presents to her primary care physician because of painless enlargement of a mass on the right side of her neck, which has evolved over several months. Palpation of the mass during physical exam locates the mass to approximately the same location as the right lobe of the thyroid gland and to be about 1.5 cm in size. Of the following, what is the most likely diagnosis?
A. Lymphocyte predominant Hodgkin disease
B. Burkitt lymphoma
C. Extra-nodal marginal zone lymphoma
D. Metastatic breast carcinoma
E. Occult trauma
Answer for Question 124
Answer: C (Extra-nodal marginal zone lymphoma)
Explanation: Individuals with a chronic inflammatory process (such as Hashimoto thyroiditis, but also Sjogren syndrome and chronic gastritis among others) are at risk for the development of an extra-nodal marginal zone lymphoma, which is a relatively indolent neoplasm, hence the slow growth. While lymphocyte predominant Hodgkin disease can present in a cervical location, it is a rare form of Hodgkin disease and would essentially not occur within the thyroid gland itself. Burkitt lymphoma and metastatic breast carcinoma are more aggressive, and slow growth would be less likely, and they are not associated with Hashimoto thyroiditis. While occult trauma could cause a hematoma, which could present as a mass, given the time frame, this would most likely have resolved.