A 48 year old woman was admitted with a history of weakness for two months. On examination, cervical lymph nodes were found enlarged and spleen was palpable 2 cm below the costal margin. Her hemoglobin was 10.5 g/dl, platelet count 2.7 X 1091L and total leukocyte count 40 X 109/ L, which included 80% mature lymphoid cells with coarse clumped chromatin. Bone marrow revealed a nodular lymphoid infiltrate. The peripheral blood lymphoid cells were positive for CD 19, CD5, CD20 and CD23 and were negative for CD 79 B and FMC-7.The histopathological examination of the lymph node in this patient will most likely exhibit effacement of lymph node arachitecture by –
A 48 year old woman was admitted with a history of weakness for two months. On examination, cervical lymph nodes were found enlarged and spleen was palpable 2 cm below the costal margin. Her hemoglobin was 10.5 g/dl, platelet count 2.7 X 1091L and total leukocyte count 40 X 109/ L, which included 80% mature lymphoid cells with coarse clumped chromatin. Bone marrow revealed a nodular lymphoid infiltrate. The peripheral blood lymphoid cells were positive for CD 19, CD5, CD20 and CD23 and were negative for CD 79 B and FMC-7.The histopathological examination of the lymph node in this patient will most likely exhibit effacement of lymph node arachitecture by –
💡 Explanation
**Question:** The histopathological examination of the lymph node in this patient will most likely exhibit effacement of lymph node architecture by -
A. Lymphoma
B. Lymphadenitis
C. Lymphoma with germinal center involvement
D. Lymphoma with mantle zone involvement
**Core Concept:** Histopathological examination of lymph node biopsies in suspected lymphoproliferative disorders helps in determining the type of lymphoma and its specific subtype. Lymphoma is a group of malignancies arising from lymphocytes, characterized by the effacement of lymph node architecture.
**Why the Correct Answer is Right:** In this case, the clinical presentation and laboratory findings point towards a lymphoproliferative disorder. The patient's history of lymphadenopathy, splenomegaly, elevated lymphocyte count, and positivity for CD19, CD5, CD20, and CD23 on flow cytometry support the diagnosis.
**Why Each Wrong Option is Incorrect:**
A. Lymphadenitis (inflammatory disorder) - Although lymphadenopathy is seen in lymphadenitis, the histopathological examination would show reactive lymphoid hyperplasia with preserved lymph node architecture.
B. Lymphoma with germinal center involvement - While germinal center involvement is common in lymphomas, the correct answer should reflect the overall lymphoma subtype, not just a specific germinal center involvement.
C. Lymphoma with mantle zone involvement - Mantle zone involvement is found in some lymphomas but does not encompass all lymphomas.
D. Lymphoma with mantle zone involvement - Similar to option C, mantle zone involvement is seen in some lymphomas but is not the only feature of all lymphomas.
**Clinical Pearl:** Histopathology plays a crucial role in diagnosing lymphomas. The presence of effacement of lymph node architecture along with the immunophenotype helps in determining the lymphoma subtype. In this case, the correct answer should encompass the overall lymphoma subtype, not just a specific germinal center involvement or mantle zone involvement.
**Correct Answer:** The correct answer should encompass the overall lymphoma subtype, not just a specific germinal center involvement or mantle zone involvement. Therefore, the correct answer is:
**Correct Answer:** Lymphoma with effacement of lymph node architecture
**Why This is Right:** Effacement of lymph node architecture is a key feature of lymphoma. It indicates the infiltration and replacement of the normal architecture of a lymph node by malignant lymphoid cells, which disrupts the normal lymph node architecture.
**Why the Other Options are Incorrect:**
A. Lymphadenitis: This is a benign inflammatory disorder and does not involve the lymph node architecture, making it an incorrect choice.
B. Lymphoma with germinal center involvement: While germinal center involvement is a common feature in B cell lymphomas, it is not the sole feature that defines the overall lymphoma subtype, making it an incorrect choice.
C. Lymphoma with mantle zone involvement: Similar to option B, mantle zone involvement is a feature of some lymphomas but is not a defining feature of the overall lymphoma subtype
✓ Correct Answer: D. A diffuse proliferation of medium to large lymphoid cells with high mitotic rate
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