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 × 109/L and total leukocyte count 40 × 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 architecture 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 × 109/L and total leukocyte count 40 × 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 architecture by –
💡 Explanation
**Core Concept**
The question tests the understanding of **lymphoid malignancies**, specifically the diagnosis and histopathological features of **chronic lymphocytic leukemia (CLL)** and its impact on lymph node architecture. CLL is characterized by the accumulation of mature lymphoid cells in the blood, bone marrow, and lymphoid organs.
**Why the Correct Answer is Right**
The patient's presentation with lymphocytosis, anemia, thrombocytopenia, and splenomegaly, along with the specific immunophenotypic profile (CD19, CD5, CD20, and CD23 positive, and CD79b and FMC-7 negative), is diagnostic of **CLL**. The histopathological examination of the lymph node in CLL typically shows **effacement of lymph node architecture** by a diffuse or nodular infiltrate of small, mature-appearing lymphocytes.
**Why Each Wrong Option is Incorrect**
**Option A:** Incorrect because it does not correspond to the typical histological findings in CLL.
**Option B:** Incorrect as it is not the characteristic feature of CLL.
**Option C:** Incorrect because it is not the typical description of lymph node involvement in CLL.
**Option D:** Incorrect as it is the correct description of lymph node involvement in CLL, thus it should be the correct answer choice.
**Clinical Pearl / High-Yield Fact**
A key point to remember is that CLL cells typically co-express **CD5 and CD20**, which helps differentiate them from other lymphoid malignancies. The diagnosis of CLL also relies on the presence of **clonal lymphocytosis** in the blood, bone marrow, or lymphoid tissues.
**Correct Answer:** D. a diffuse small lymphocytic infiltrate
✓ Correct Answer: A. A pseudofollicular pattern with proliferation centers
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