Pathology: USMLE Q No. 11

[Cardiac Arrest]

A 19-year-old man consults his physician because of unexplained weight loss and night sweats. Physical examination shows painless enlarged lymph nodes and splenomegaly. A lymph node biopsy specimen shows small numbers of a characteristic cell type (see attachment). This cell is large and often binucleate, with a prominent nucleolus in each nucleus. This patient is most likely to have which of the following conditions?

A. Histiocytic necrotizing lymphadenitis
B. Hodgkin’s disease
C. Sarcoidosis
D. Sinus histiocytosis
E. Syphilis

[GoldenButterfly]

these are owl eyes ain't they?
I think its
B.Hodgkin's ds

[Cardiac Arrest]

Option B (Hodgkin’s disease) is correct. The large neoplastic cell in this figure is a Reed-Sternberg cell (“owl eye” cell), which is characteristic but not diagnostic of Hodgkin’s disease. Reed-Sternberg cells commonly make up only a small percentage of the cell population and are now believed to be derived from B cells.

Option A (Histiocytic necrotizing lymphadenitis) is incorrect. Histiocytic necrotizing lymphadenitis (HNL or Kikuchi’s disease) is a benign self-limiting condition of uncertain etiology. Its clinical symptoms can be confused with Hodgkin’s disease. Lymph nodes in HNL show nodular necrosis in the paracortex or less often in the cortex, with fibrin deposits, karyorrhexis, and extensive macrophage infiltration. The large cell type seen in this micrograph is not found in HNL.

Option C (Sarcoidosis) is incorrect. Sarcoidosis is a disease of unknown etiology that can affect lymph nodes, causing noncaseating granulomas. Epithelioid cells and multinucleate giant cells are present, but they do not have the prominent nucleoli seen in the illustrated cell.

Option D (Sinus histiocytosis) is incorrect. Sinus histiocytosis occurs in lymph nodes that are draining sites of malignant disease or infection. The lymph sinuses within the node become enlarged and contain numerous histiocytes (macrophages).

Option E (Syphilis) is incorrect. Syphilis is one of several conditions that cause follicular hyperplasia. Abnormally large numbers of secondary follicles develop in the node and are not strictly limited to the outer cortex. The large cell type seen in this micrograph is not found in syphilitic lymph nodes.

[uday]

seems like Hodgkins

[f_ameer376]

thaaaaaaaaaaanx