Hinda Mundy, 26 years old, grew concerned when a lump appeared in her lower neck and she had pain in her chest and a dry cough

Question

She also told her physician that she had experienced fatigue, night sweats, unintentional weight loss, pruritis (dry, itchy skin), and intermittent fevers over the past few months. Immunohistological staining of a biopsy of the enlarged lymph node revealed the presence of large multinucleated Reed–Sternberg cells. Polymerase chain reaction (PCR) tests confirmed immunoglobulin gene rearrangements; however, B-cell antigen expression was absent. Hinda entered complete remission after treatment with four cycles of chemotherapy combined with radiotherapy. These symptoms and treatment are most consistent with a diagnosis of
a. Hodgkin's lymphoma
b. multiple myeloma
c. acute lymphoblastic leukemia (ALL)
d. Waldenström's magroglobulinemia
e. chronic lymphocytic leukemia (CLL).

What will be an ideal response?

Answer 1

Rationale: The correct answer is a. Two clues are crucial to this diagnosis: the first is the presence of Reed–Sternberg cells, a hallmark of Hodgkin's lymphoma; the second is the existence of rearranged immunoglobulin loci in these cells but their inability to express mature B-cell receptors. Multiple myeloma, Waldenström's magroglobulinemia, and CLL, in contrast, are B-cell tumors that do make mature B-cell receptors. ALL derives from a lymphoid progenitor, and the immunoglobulin loci are unrearranged.