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Lymphadenopathy — ABIM Board MCQ

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HardHematology/OncologyLymphadenopathyABIM Board

A 44-year-old man has painless cervical and mediastinal lymphadenopathy, drenching night sweats and weight loss. Fine-needle aspiration reports an atypical lymphoid population but cannot classify it; an enlarged cervical node is safely accessible. Which diagnostic step is most appropriate?

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Correct answer: D — Obtain an excisional cervical lymph-node biopsy

The best answer is “Obtain an excisional cervical lymph-node biopsy”. Lymphoma classification depends on architecture, morphology, immunophenotype and often molecular studies. An accessible node should be excised when feasible after nondiagnostic aspiration. PET-CT and biomarkers assist staging or prognosis but cannot replace adequate diagnostic tissue, and glucocorticoids can obscure pathology.

Reference: NCI Adult Hodgkin Lymphoma Treatment (PDQ): https://www.cancer.gov/types/lymphoma/hp/adult-hodgkin-treatment-pdq