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 1091 L 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 1091 L 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
**Core Concept**
The patient's presentation of lymphadenopathy, splenomegaly, anemia, thrombocytopenia, and a high leukocyte count with mature lymphoid cells suggests a lymphoproliferative disorder, specifically chronic lymphocytic leukemia (CLL). CLL is characterized by the clonal expansion of mature, functionally incompetent lymphocytes, leading to disruption of normal lymph node architecture.
**Why the Correct Answer is Right**
The patient's immunophenotypic profile (CD19+, CD5+, CD20+, CD23+, CD79B-, FMC-7-) is consistent with CLL, a malignancy of mature B cells. The presence of CD5, a marker typically associated with T cells, is a hallmark of CLL. The effacement of lymph node architecture by CLL cells is a result of their accumulation and proliferation, leading to the destruction of normal lymphoid tissue.
**Why Each Wrong Option is Incorrect**
* **Option A:** This option is not mentioned in the question stem, which makes it an invalid choice.
* **Option B:** While lymphoma can also disrupt lymph node architecture, the patient's immunophenotypic profile and clinical presentation are more consistent with CLL than lymphoma.
* **Option C:** This option is not a valid choice, as it is not mentioned in the question stem.
* **Option D:** This option is not a valid choice, as it is not mentioned in the question stem.
**Clinical Pearl / High-Yield Fact**
In CLL, the presence of CD5 and CD23 is a useful diagnostic clue, as these markers are often co-expressed on CLL cells. Additionally, the effacement of lymph node architecture by CLL cells can lead to lymphadenopathy and splenomegaly, which are common presenting features of the disease.
**Correct Answer:** C.
✓ Correct Answer: D. A diffuse proliferation of medium to large lymphoid cells with high mitotic rate
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