MEDizzy - A 33-year-old woman has experienced low grade fevers, night

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Combined Hematology II

A 33-year-old woman has experienced low grade fevers, night sweats, and generalized malaise for the past 2 months. On physical examination she has non-tender cervical and supraclavicular lymphadenopathy. A cervical lymph node biopsy is performed. On microscopic examination at high magnification there are occasional CD15+ and CD30+ Reed-Sternberg cells along with large and small lymphocytes and bands of fibrosis. Which of the following is the most likely diagnosis?

ExplanationB. The characteristic CD15+ and CD30+ Reed-Sternberg cells is seen in Hodgkin Lymphoma. Burkitt lymphoma will not have this type of immunophenotype and morphology. Mycosis fungoides is a T-cell neoplasm with CD4 positivity. Multiple myeloma also will not have this morphology and immunophenotype, infact it is very rare to have lymphadenopathy in myeloma. Cat scratch disease is caused by Bartonella henselae and occurs after cat scratch. Commonly presents as tender, swollen lymph nodes near the site of the inoculating bite or scratch or on the neck and is usually limited to one side. This condition is referred to as regional lymphadenopathy and occurs 1-3 weeks after inoculation. Lymphadenopathy in CSD most commonly occurs in the arms, neck, or jaw, but may also occur near the groin or around the ear. Most patients also develop systemic symptoms such as malaise, decreased appetite, and aches. Other associated complaints include headache, chills, muscular pains, joint pains, arthritis, backache and abdominal pain. It may take 7 to 14 days, or as long as two months, before symptoms appear. Most cases are benign and selflimiting, but lymphadenopathy may persist for several months after other symptoms disappear. The disease usually resolves spontaneously, with or without treatment, in one month.