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.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

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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.

Hinda Mundy,26 Years Old,grew Concerned When a Lump Appeared in Her