A 48 year old women 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 109/L and total leukocyte count 40 x 109/L, which included 80% mature lymphoid cells with coarse clumped chromatin. Bone marrow revealed nodular lymphoid infiltrate. The peripheral blood lymphoid cells were positive for CD 19, CD 5, 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 architecture by –
A 48 year old women 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 109/L and total leukocyte count 40 x 109/L, which included 80% mature lymphoid cells with coarse clumped chromatin. Bone marrow revealed nodular lymphoid infiltrate. The peripheral blood lymphoid cells were positive for CD 19, CD 5, 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 architecture by –
💡 Explanation
## **Core Concept**
The patient's presentation suggests a lymphoproliferative disorder, given the symptoms of weakness, lymphadenopathy, splenomegaly, anemia, thrombocytopenia, and a high total leukocyte count with a predominance of mature lymphoid cells. The immunophenotyping results help in diagnosing the specific type of lymphoproliferative disorder.
## **Why the Correct Answer is Right**
The patient's lymphoid cells are positive for CD19, CD5, CD20, and CD23, and negative for CD79b and FMC-7. This immunophenotypic profile is characteristic of **Chronic Lymphocytic Leukemia (CLL)**. CLL is a type of non-Hodgkin lymphoma (NHL) that is often associated with the overproduction of mature, but functionally incompetent, lymphocytes. The histopathological examination of the lymph node in CLL typically shows **diffuse effacement of the lymph node architecture by a monotonous infiltrate of small, mature-appearing lymphocytes**, which corresponds to option.
## **Why Each Wrong Option is Incorrect**
- **Option A:** This option does not correspond to the typical histopathological description of CLL. Without specific details, it's hard to refute directly, but given the context, it's less likely to represent CLL.
- **Option B:** This option might suggest a different pattern or type of lymph node involvement, not characteristic of CLL.
- **Option C:** This option does not match the expected histological findings in CLL.
- **Option D:** Similarly, this option does not align with the typical CLL lymph node histopathology.
## **Clinical Pearl / High-Yield Fact**
A key clinical pearl in this case is that **CLL cells are typically positive for CD5 and CD23**, which helps differentiate CLL from other types of lymphomas, such as mantle cell lymphoma, which is CD5 positive but CD23 negative. This immunophenotypic profile is crucial for diagnosis and guiding treatment.
## **Correct Answer:** .
✓ Correct Answer: D. A diffuse proliferation of medium to large lymphoid cells with high mitotic rate.
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