Reed-Sternberg cells are distinctive, giant cells have light microscopy in biopsies from individuals with the… - DSSSB 13 August 2024

DSSSB 13 August 2024

Pathology & Genetics

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Appeared in: DSSSB 13 August 2024

Explanation

Reed-Sternberg (RS) cells are the definitive histopathological hallmark required for the diagnosis of classic Hodgkin's Lymphoma.
These are large, abnormal lymphocytes, derived from germinal center B cells, that have lost their typical B-cell characteristics.
Classic RS cells are often large (up to 45 μm), with either multiple nuclei or a single bilobed nucleus, and possess prominent, eosinophilic (pink-staining) nucleoli.
This structure, with two mirror-image nuclei, creates the pathognomonic 'owl-eye' appearance on microscopic examination.
The diagnosis is confirmed by identifying these cells within a background of non-neoplastic inflammatory cells (lymphocytes, eosinophils, etc.).

Option A: Thalassemia is a genetic blood disorder involving abnormal hemoglobin synthesis. Its diagnosis is based on blood tests and hemoglobin electrophoresis, and a blood smear would show microcytic, hypochromic red blood cells, not giant malignant cells.
Option B: Haemophilia is a genetic bleeding disorder resulting from a deficiency in specific coagulation factors (e.g., Factor VIII or IX). It is a functional disorder of hemostasis and does not produce any characteristic cellular abnormalities in tissue biopsies.
Option D: Wilm's tumour, or nephroblastoma, is a kidney cancer that primarily affects children. Its histology is classically 'triphasic,' showing three different cell types: blastemal, epithelial, and stromal elements. It is not associated with Reed-Sternberg cells.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Histopathological features of Hodgkin's Lymphoma as background academic context rather than a clinical decision trigger.
The identification of Reed-Sternberg cells in a biopsy is the gold standard for diagnosing Hodgkin's Lymphoma, distinguishing it from non-Hodgkin lymphomas and other causes of lymphadenopathy.
A definitive diagnosis allows for accurate staging of the disease and the initiation of appropriate treatment protocols (e.g., chemotherapy, radiation), which have led to high cure rates for Hodgkin's Lymphoma.
What if? If the biopsy showed large 'popcorn-like' cells that were positive for CD20 but negative for CD15 and CD30, the diagnosis would shift to Nodular Lymphocyte-Predominant Hodgkin Lymphoma (NLPHL), a non-classic subtype with a different treatment approach and typically a more indolent course.

How to Approach the Question

This is a factual recall question that tests your knowledge of pathology.
First, identify the key term in the question stem: 'Reed-Sternberg cells'.
Access your knowledge base of hematology and oncology.
Recall the classic, pathognomonic association of Reed-Sternberg cells with a specific malignancy.
Evaluate the options provided: Thalassemia (a hemoglobinopathy), Haemophilia (a clotting disorder), Hodgkin's Lymphoma (a lymphoid malignancy), and Wilm's tumour (a pediatric kidney cancer).
Select the option that directly corresponds to the key term. The link between Reed-Sternberg cells and Hodgkin's Lymphoma is a fundamental concept in pathology and nursing oncology.

Concept Tested & Keywords

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E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed pp. 615-617, 616-618