Which diagnostic test determines the presence of Hodgkin's lymphoma?

DSSSB - 28 August 2019 (Shift-1)

Medical & Surgical Nursing

Easy

Appeared in: DSSSB - 28 August 2019 (Shift-1)

Explanation

The definitive diagnosis of Hodgkin's lymphoma requires a lymph node biopsy to identify the hallmark cell of the disease.
This hallmark is the Reed-Sternberg (R-S) cell, a large, abnormal B lymphocyte.
R-S cells are characteristically large and often have two nuclei (binucleated) with prominent nucleoli, giving them a classic 'owl's eye' appearance, as shown in the image.
The presence of these specific cells distinguishes Hodgkin's lymphoma from all other types of lymphoma and cancer.

Option A: The Philadelphia chromosome is a specific genetic abnormality (a translocation between chromosomes 9 and 22) that is the hallmark of Chronic Myeloid Leukemia (CML), not Hodgkin's lymphoma.
Option B: The presence of a high percentage of lymphoblasts (immature lymphocytes) in the bone marrow is the key diagnostic feature of Acute Lymphoblastic Leukemia (ALL). Hodgkin's lymphoma originates in lymph nodes, and the malignant cells are Reed-Sternberg cells, not lymphoblasts.
Option C: Finding malignant cells in the cerebrospinal fluid (CSF) indicates that a cancer has spread to the central nervous system (meningeal involvement). While this can happen in advanced lymphomas or leukemias, it is not the primary diagnostic test for Hodgkin's lymphoma, which is diagnosed from a lymph node.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Diagnostic markers for hematological malignancies as background academic context rather than a clinical decision trigger.
Accurate histological diagnosis is critical in oncology nursing. Differentiating Hodgkin's lymphoma (HL) from non-Hodgkin lymphoma (NHL) based on the presence or absence of Reed-Sternberg cells is the first step in determining the correct treatment protocol and predicting the patient's prognosis.
Nurses play a key role in managing patients undergoing diagnostic procedures like lymph node biopsy, including patient education, post-procedure care, and monitoring for complications like bleeding or infection.
What if? - What if the biopsy report described 'popcorn cells' (lymphohistiocytic variants) that were positive for CD20 but negative for CD15 and CD30? The diagnosis would change to Nodular Lymphocyte-Predominant Hodgkin Lymphoma (NLPHL), a rare subtype with a different immunophenotype and typically a more indolent course and treatment approach compared to classical Hodgkin's lymphoma.

How to Approach the Question

First, identify the key concept in the question stem: the specific diagnostic test for 'Hodgkin's lymphoma'.
This is a factual recall question that tests your knowledge of the pathognomonic (uniquely characteristic) signs of specific diseases.
Mentally review the key diagnostic markers for common hematologic malignancies.
Evaluate each option: A) Philadelphia chromosome is famously linked to CML. B) Lymphoblasts in marrow point to ALL. C) Malignant cells in CSF indicate CNS spread, not a primary diagnosis.
Recognize that the Reed-Sternberg cell is the textbook hallmark of Hodgkin's lymphoma. The image provided visually reinforces this fact.
Select the option that correctly pairs the disease with its definitive diagnostic finding.

Concept Tested & Keywords

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E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 615-617

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 629-631