A 45 year old lady presented with painless neck swelling since 3months associated with loss of weight and fever. FNAC of the same showed a polymorphous population of lymphocytes, cosinophils, plasma cells and large binculeate cells with nucleus having Owl-eye appearance. What is your diagnosis

**Core Concept**
The patient's presentation of painless neck swelling, weight loss, and fever, along with specific cytological features on fine-needle aspiration cytology (FNAC), suggests a diagnosis of a lymphoproliferative disorder. The presence of a polymorphous population of lymphocytes, eosinophils, plasma cells, and large binucleate cells with an "owl-eye" nucleus is characteristic of certain types of lymphoma.

**Why the Correct Answer is Right**
The described cytological features are typical of a lymphoma, specifically a type of non-Hodgkin lymphoma (NHL). The "owl-eye" nucleus, also known as a "cloverleaf" or "vacuolated" nucleus, is a distinctive feature of large B-cell lymphoma, particularly of the diffuse large B-cell lymphoma (DLBCL) subtype. This type of lymphoma often presents with systemic symptoms such as weight loss, fever, and night sweats, and can cause painless lymphadenopathy.

**Why Each Wrong Option is Incorrect**
* **Option A:** This option is incorrect because the described cytological features do not match those of Hodgkin lymphoma, which typically presents with a "reed-sternberg" cell.
* **Option B:** This option is incorrect because the presence of a polymorphous population of lymphocytes, eosinophils, and plasma cells is not characteristic of follicular lymphoma, which typically shows a monotonous population of small lymphocytes.
* **Option C:** This option is incorrect because the described cytological features do not match those of chronic lymphocytic leukemia (CLL), which typically presents with a monotonous population of small lymphocytes.

**Clinical Pearl / High-Yield Fact**
In patients presenting with painless lymphadenopathy and systemic symptoms, it is essential to consider lymphoma in the differential diagnosis. A prompt and accurate diagnosis can significantly impact treatment outcomes.

**Correct Answer: D. Diffuse Large B-cell Lymphoma (DLBCL)**

✓ Correct Answer: B. Mixed cellulority