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DLBCL — RACP Adult Medicine MCQ

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ModerateHaematologyDLBCLRACP Adult Medicine

A 65-year-old man presents with rapidly enlarging cervical lymphadenopathy over 4 weeks, B symptoms, and elevated LDH. CT shows widespread nodal and extranodal disease (hepatic and splenic lesions). Lymph node biopsy shows large, diffuse proliferation of CD20-positive B cells with high Ki-67 (>90%). What is the most likely diagnosis?

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Correct answer: E — Non-Hodgkin lymphoma (DLBCL)

Rapidly enlarging lymphadenopathy with B symptoms, elevated LDH, extranodal disease, and biopsy showing diffuse large CD20+ B cells with high proliferation index is DLBCL — the most common aggressive NHL. Treatment is R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) for 6 cycles. Cure rates are 60–70% with R-CHOP.

Reference: ALLG – 2024 – DLBCL; NCCN 2025