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Unexplained lymphadenopathy suspicious for lymphoma — ABIM Board MCQ

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HardGeneral Internal MedicineUnexplained lymphadenopathy suspicious for lymphomaABIM Board

A 64-year-old man has unintentional weight loss and a new 2-cm left supraclavicular lymph node. CT chest, abdomen, and pelvis shows multiple enlarged mediastinal and retroperitoneal nodes but no obvious primary mass. CBC shows mild anemia. Which of the following is the most appropriate diagnostic study?

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Correct answer: C — Excisional lymph node biopsy or core biopsy adequate for architecture and immunophenotyping

Suspected lymphoma requires tissue adequate for architecture, flow cytometry, immunohistochemistry, and molecular studies. Excisional biopsy is preferred when feasible; empiric treatment without diagnosis is inappropriate in a stable patient.

Reference: NCCN B-Cell Lymphoma Diagnostic Guidance