A 42-year-old previously healthy woman comes to the office due to fever and sore throat. She has no cough. Physical examination shows tonsillar exudate and a nontender cervical lymph node that measures 3.5 cm in diameter. Oral antibiotic therapy is started and on a follow-up visit a week later, the patient reports that her symptoms have resolved. The previously enlarged cervical lymph node has decreased slightly in size. On several follow-up visits over the following year, the patient remains asymptomatic and the size of the lymph node fluctuates but does not disappear completely. The patient is referred to a specialist for surgical removal of the enlarged node. Biopsy reveals abnormal lymph node architecture and numerous lymphocytes. Which of the following, if present, would be most consistent with malignancy in this patient?

Question

A 42-year-old previously healthy woman comes to the office due to fever and sore throat.  She has no cough.  Physical examination shows tonsillar exudate and a nontender cervical lymph node that measures 3.5 cm in diameter.  Oral antibiotic therapy is started and on a follow-up visit a week later, the patient reports that her symptoms have resolved.  The previously enlarged cervical lymph node has decreased slightly in size.  On several follow-up visits over the following year, the patient remains asymptomatic and the size of the lymph node fluctuates but does not disappear completely. The patient is referred to a specialist for surgical removal of the enlarged node.  Biopsy reveals abnormal lymph node architecture and numerous lymphocytes.  Which of the following, if present, would be most consistent with malignancy in this patient?

Quizplus · Accepted Answer

Eductional Objective: Benign lymph node enlargement in response to antigenic stimulation is associated with a polyclonal proliferation of lymphocytes.  A monoclonal lymphocytic proliferation is strong evidence of malignancy.

A 42-Year-Old Previously Healthy Woman Comes to the Office Due