Robbin Path Q

[MudPhud20XX]

A 63 yr old man has noticed a lump in his neck for 2 months. Examination reveals a group of three discrete nontender right posterior cervical lymph nodes, and a mass of enlarged right axillary lymph nodes. Chest and abdominal CT scans show mediastinal lymphadenopathy and hepatosplenomegaly. A cervical lymph node biopasy reveals abundant large CD 15+ and CD 30+ binucleate cells with prominent acidophilic nucleoli, scattered within a sparse lymphocytic infiltrate. What is molecular analysis of this lesion most likely to reveal?

A. Clonal EBV integration in the large cells
B. BCL6 gene rearrangements in the large cells
C. Deletions of 5q in all the cells
D. Helicobacter pylori infection in all the cells
E. JAK2 gene mutations in the lymphocytes

Based on the question stem --> RS cell thus, Hodgkin lymphoma. But the answer is A. Isn't EBV associated with Burkitt lymphoma which is considered as Non-hodgkin lymphoma? I am a bit confused now... Can anyone help me out?

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[SBR249]

It is not correct to associate EBV with just non-Hodgkin lymphoma or Burkitt lymphoma. EBV is latent in B lymphocytes and causes them to proliferate and transform. Thus EBV is a general oncogenic virus and may contribute to the pathogenesis of most B cell malignancies. In fact, EBV can be highly associated with Hodgkin lymphoma, Burkitt lymphoma, diffuse large B cell lymphoma, primary CNS lymphoma, etc. So considering this, EBV by itself is a pretty non-specific marker.

However context is very important, especially when combined with the presence of EBV. EBV is almost universally associated with the endemic variant of Burkitt in Africa whereas the association is less strong with the sporadic form common in the rest of the world and you are better off associating that with the IGH-Myc translocation instead. Another strong association of EBV is primary CNS lymphoma in an immunocompromised patient.

tl;dr: EBV is pretty non-specific for most of the B cell malignancies if you are considering it without further context.

 

[MudPhud20XX]

It is not correct to associate EBV with just non-Hodgkin lymphoma or Burkitt lymphoma. EBV is latent in B lymphocytes and causes them to proliferate and transform. Thus EBV is a general oncogenic virus and may contribute to the pathogenesis of most B cell malignancies. In fact, EBV can be highly associated with Hodgkin lymphoma, Burkitt lymphoma, diffuse large B cell lymphoma, primary CNS lymphoma, etc. So considering this, EBV by itself is a pretty non-specific marker.

However context is very important, especially when combined with the presence of EBV. EBV is almost universally associated with the endemic variant of Burkitt in Africa whereas the association is less strong with the sporadic form common in the rest of the world and you are better off associating that with the IGH-Myc translocation instead. Another strong association of EBV is primary CNS lymphoma in an immunocompromised patient.

tl;dr: EBV is pretty non-specific for most of the B cell malignancies if you are considering it without further context.

thank you so much!!!!

 

[Brain Bucket]

Years from now, I think it would be pretty funny to bump your (potentially by then) thousands of threads. Seriously, could you make a single thread or something? The first page alone contains 14 threads created by you. Maybe a subforum could be created for you?

 

[Transposony]

I don't know about years from now, but I will certainly remember many concepts solely due to these threads.

 

[Brain Bucket]

Wouldn't it be nicer if you could revisit them in one location should you need clarification? Most of his questions are so basic/easy to look up that it makes me think that he's a premed who couldn't wait.

 

[SBR249]

The OP has said he's doing review stuff as he goes along in MS2 which I'm taking to mean he's doing the qbanks as the year progresses. However, I do have to admit that sometimes the questions make me question the quality of the medical education at the school. Either that or the OP just couldn't wait and is skipping around and doing some questions before covering the materials at school which would be somewhat of a waste of review material. Considering the breadth of the questions asked and the fact that it's only September, I'm inclined to go with the latter.