A 63-year-old man has noticed a lump in his neck for 2 months. Examination reveals a group of three discrete nontender right posterior cervical lymph nodes, and a mass of enlarged right axillary lymph nodes. Chest and abdominal CT scans show mediastinal lymphadenopathy and hepatosplenomegaly. Microscopic examination of a cervical lymph node biopsy reveals abundant large CD15+ and CD30+ binucleate cells with prominent acidophilic nucleoli, scattered within a sparse lymphocytic infiltrate. What is molecular analysis of this lesion most likely to reveal?
Correct Answer: Clonal EBV integration in the large cells
Description: The lymphocyte depletion variant of Hodgkin lymphoma has an abundance of Reed-Sternberg cells and a paucity of lymphocytes. Most cases present with advanced disease (stage IV in this example). Epstein-Barr virus (EBV) is present in over 90% of cases. BCL6 gene rearrangements are typical of diffuse large B-cell lymphomas. Deletions of 5q are typical of myelodysplastic syndrome. Infection with Helicobacter pylori can give rise to marginal zone lymphoma. JAK2 mutations are found in polycythemia vera and other myeloproliferative diseases.
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Pathology
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