A 35-year-old man is being evaluated for nontender cervical lymphadenopathy that he first noticed while shaving. A biopsy is performed, and a low-magnification image of the lymph node histology is shown below. Cytogenetic analysis would most likely demonstrate which of the following patterns?

Question

A 35-year-old man is being evaluated for nontender cervical lymphadenopathy that he first noticed while shaving.  A biopsy is performed, and a low-magnification image of the lymph node histology is shown below.  Cytogenetic analysis would most likely demonstrate which of the following patterns?

Quizplus · Accepted Answer

11ec160b_398d_fab5_9249_673b2c26d8c7_MD0001_00 The image demonstrates the classic histology of follicular lymphoma, a type of non-Hodgkin's lymphoma. Follicular lymphoma is a B-cell tumor composed predominantly of centrocytes (small cleaved cells) and fewer numbers of centroblasts (large noncleaved cells). At low magnification, aggregates of packed follicles (arrows) that obscure the normal lymph node architecture are seen. The t(14;18) translocation is found in 80%-90% of follicular lymphomas. The result is overexpression of the antiapoptotic gene product, BCL-2, and tumor formation. (Choices B and D) BCR-ABL rearrangement t(9;22) is found in chronic myelogenous leukemia (CML). CML is a myeloproliferative disorder, not a lymphoproliferative disorder as shown in the image above. The BCR-ABL fusion gene directs the synthesis of a constitutively active protein tyrosine kinase that affects multiple intracellular signaling pathways, leading to uncontrolled proliferation. (Choice C) All Burkitt lymphomas are associated with translocations of the C-MYC gene on chromosome 8, usually onto the Ig heavy chain region of chromosome 14 [t(8;14)]. Histologically, Burkitt lymphoma shows a diffuse population of medium-sized lymphocytes with a "starry sky" appearance due to the high proliferation index and high rate of apoptosis. (Choice E) Overexpression of N-MYC proto-oncogene protein is common in neuroblastoma and small cell carcinoma of the lung. Educational objective: Follicular lymphoma is characterized by aggregates of packed follicles that obscure the normal lymph node architecture. Ninety percent of patients with follicular lymphoma have the t(14;18) translocation, which causes overexpression of the antiapoptotic BCL-2 protein.

A 35-Year-Old Man Is Being Evaluated for Nontender Cervical Lymphadenopathy