QUIZ: Lymphoma

 

🧠 Lymphoma Quiz: Pathophysiology and Clinical Features

This quiz is designed to help medical students consolidate their knowledge of lymphoma subtypes, clinical presentations, and diagnostic clues. Test your understanding of Hodgkin and non-Hodgkin lymphomas through five case-based questions.

 

1. A 21-year-old woman presents with a painless lump in her neck and drenching night sweats. Examination reveals a firm, non-tender cervical lymph node. A lymph node biopsy shows large binucleate cells with prominent nucleoli in an inflammatory background.

Which of the following best describes the abnormal cells seen in this condition?

A. Neoplastic B cells with CD5 and CD23 expression
B. T-cell blasts with high mitotic activity
C. Centrocytes forming follicular structures
D. Reed-Sternberg cells of B-cell origin
E. Plasma cells with perinuclear clearing

2. A 42-year-old man presents with weight loss, fatigue, and a 3-month history of low-grade fevers and night sweats. He also reports painless lymph node swelling in the axilla. Biopsy confirms a diagnosis of lymphoma.

Which of the following features indicates the presence of B-symptoms?

A. Splenomegaly on imaging
B. CD20 expression on flow cytometry
C. Unintentional weight loss >10% over 6 months
D. Normocytic anaemia
E. Cervical and axillary lymphadenopathy

3. A 64-year-old man presents with a rapidly enlarging, painless lymph node in his neck. He reports night sweats and fatigue. Biopsy and Immunochemistry reveals large CD20 positive lymphoid cells with a high mitotic rate.

Which of the following best describes this lymphoma?

A. Low-grade lymphoma with follicular architecture
B. T-cell lymphoma often involving skin
C. Indolent lymphoma with CD5 expression
D. Aggressive B-cell lymphoma with rapid growth
E. Plasma cell neoplasm with rouleaux formation

4. A 10-year-old boy from rural Africa presents with a rapidly enlarging jaw mass and fever. Biopsy shows a “starry sky” appearance on histology, and high-grade B-cell lymphoma is diagnosed.

Which virus is most strongly associated with this malignancy?

A. Human herpesvirus 8 (HHV-8)
B. Epstein-Barr virus (EBV)
C. Human papillomavirus (HPV)
D. Hepatitis B virus (HBV)
E. Human T-cell leukaemia virus (HTLV-1)

5. A 58-year-old man is diagnosed with diffuse large B-cell lymphoma. He has multiple rapidly enlarging lymph nodes in the neck and abdomen. PET scan shows extranodal involvement in the bowel wall.

Which of the following features best differentiates non-Hodgkin lymphoma from Hodgkin lymphoma?

A. T-cell origin
B. Predictable contiguous spread
C. Mediastinal predominance
D. Frequent extranodal involvement
E. Presence of eosinophils in biopsy

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Answer Explanations

1. Correct answer: D. Reed-Sternberg cells of B-cell origin
Hodgkin lymphoma is characterised by Reed-Sternberg cells — large, binucleate or multinucleate B-cells with "owl-eye" nucleoli, usually CD15+ and CD30+. These are derived from germinal centre B-cells. The surrounding inflammatory background makes up most of the tumour mass.

2. Correct answer: C. Unintentional weight loss >10% over 6 months
B-symptoms include fevers >38°C, drenching night sweats, and weight loss >10% over 6 months. They are systemic signs of active lymphoma and have prognostic significance. Lymphadenopathy and splenomegaly are local findings and not classified as B-symptoms.

3. Correct answer: D. Aggressive B-cell lymphoma with rapid growth
Diffuse large B-cell lymphoma (DLBCL) presents as a rapidly growing mass with systemic symptoms. It is aggressive but potentially curable. CD20 confirms B-cell origin. It is distinguished from follicular lymphoma (indolent), T-cell lymphoma, and plasma cell neoplasms like myeloma.

4. Correct answer: B. Epstein-Barr virus (EBV)
Endemic Burkitt lymphoma is associated with EBV infection and often presents with jaw or facial masses in African children. The characteristic “starry sky” appearance is due to high cell turnover and macrophage infiltration.

5. Correct answer: D. Frequent extranodal involvement
Non-Hodgkin lymphoma commonly involves extranodal sites (GI tract, CNS, skin) and shows non-contiguous spread. Hodgkin lymphoma typically shows orderly spread from one node group to another and often presents with a mediastinal mass.

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