A 46-year-old smoker presents to your office with a three week history of low-grade fever, weakness and neck swelling. Biopsy of the affected tissue reveals the following histologic findings: An abnormality in which of the following tissues is most likely responsible for this patient's symptoms?

Question

A 46-year-old smoker presents to your office with a three week history of low-grade fever, weakness and neck swelling. Biopsy of the affected tissue reveals the following histologic findings:  An abnormality in which of the following tissues is most likely responsible for this patient's symptoms?

Quizplus · Accepted Answer

In order to answer this question, you must be able to recognize the characteristic histology. The tissue biopsy shows numerous lymphocytes (small cells with dark, round nuclei and a small rim of cytoplasm), meaning that it was most likely taken from a lymph node. The key finding is the giant binucleated cell, a Reed-Sternberg (RS) cell, in the center of the slide. RS cells are derived from germinal center B-lymphocytes and are the neoplastic cells of Hodgkin lymphoma (HL). RS cells must be present in order to make the diagnosis of HL. The two mirror-image nuclei of RS cells are often described as having the appearance of "owl's eyes." (Choice A) The respiratory epithelium is a pseudostratified columnar ciliated epithelium that extends down to the level of the bronchioles. At the bronchioles, the epithelium gradually becomes cuboidal and then transitions to a flat, single-celled alveolar lining of Type I pneumocytes. (Choice B) A goiter may cause neck swelling. Histologically, Hashimoto thyroiditis has the appearance of lymphocytes infiltrating between thyroid follicles. (Choice D) Reed-Sternberg cells are not associated with leukemia. The classic finding in patients with leukemia is a peripheral blood smear with leukemic cells, leukocytosis and thrombocytopenia. (Choice E) Both melanoma and squamous cell carcinoma can metastasize from the skin causing lymphadenopathy. The cells on this tissue biopsy show no evidence of squamous or melanocytic differentiation, however. Educational Objective: Reed-Sternberg cells are large binucleated cells with an "owl's eyes" appearance that appear on a background of lymphocytic infiltrates. Reed-Sternberg cells must be present histopathologically in order to make the diagnosis of Hodgkin lymphoma.

A 46-Year-Old Smoker Presents to Your Office with a Three