Hodgkin Lymphoma: The Daily PANCE Blueprint

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Hodgkin Lymphoma: The Daily PANCE Blueprint

A 24-year-old man notices a firm, painless, rubbery lump in the left side of his neck that has slowly grown over two months. He also reports drenching night sweats, an unintentional 12-pound weight loss, and occasional fevers, and he mentions that the node aches whenever he drinks alcohol. On exam he has non-tender left cervical and supraclavicular lymphadenopathy. A chest radiograph shows a widened mediastinum. Which of the following is the most appropriate next step to establish the diagnosis?

A. Excisional lymph node biopsy
B. Fine-needle aspiration of the node
C. A short course of antibiotics and reassess
D. Repeat imaging in three months
E. Bone marrow biopsy first

Answer and topic summary

The answer is A. Excisional lymph node biopsy.

A young adult with painless, rubbery lymphadenopathy, B symptoms (drenching night sweats, weight loss, fevers), alcohol-induced node pain, and a mediastinal mass has Hodgkin lymphoma until proven otherwise. The essential next step is an excisional lymph node biopsy, because the diagnosis depends on seeing the preserved nodal architecture and identifying Reed-Sternberg cells — the giant “owl-eye” binucleated cells. The trap is fine-needle aspiration: it samples scattered cells but destroys the architecture, so it cannot reliably diagnose lymphoma and only delays care. Empiric antibiotics or “watchful waiting” waste time on a curable cancer, and a bone marrow biopsy is for staging after the diagnosis is made, not to establish it.

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Covered under ⇒ PANCE Blueprint Hematology ⇒ Neoplasms, Premalignancies, and Malignancies ⇒ Lymphoma

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