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Richter Transformation — RACP Adult Medicine MCQ

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ModerateHaematologyRichter TransformationRACP Adult Medicine

A 60-year-old man with CLL develops progressive fatigue, fever, and rapidly enlarging lymphadenopathy. His LDH has risen sharply. PET-CT shows an intensely FDG-avid mass (SUVmax 18) in the right cervical region. What transformation should be suspected?

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Correct answer: B — Richter transformation (large cell lymphoma)

Richter transformation occurs in 2–10% of CLL patients and represents transformation to an aggressive lymphoma (usually diffuse large B-cell lymphoma). It should be suspected when there is rapid clinical deterioration, rapidly enlarging lymphadenopathy, B symptoms, rising LDH, and intensely FDG-avid lesions on PET-CT (SUVmax >5–10). Excisional biopsy (not fine needle aspiration) is required for diagnosis. Prognosis is poor; treatment is with R-CHOP or similar chemoimmunotherapy.

Reference: eTG – 2025 – Haematology; iwCLL – 2018 – CLL Complications