A 68-year-old man presents with fatigue, night sweats and a mediastinal mass on CT. Biopsy shows large lacunar cells with a background of eosinophils, plasma cells and lymphocytes in a nodular sclerotic pattern. CD15+, CD30+, CD45−. Staging PET-CT shows disease in mediastinum and left axilla only. Ann Arbor stage and recommended treatment are:
- A Stage II; ABVD × 2 cycles plus involved-site radiotherapy (ISRT) ✓
- B Stage IV; R-CHOP chemotherapy
- C Stage III; BV-AVD (brentuximab vedotin + AVD) chemotherapy
- D Stage II; rituximab monotherapy
Correct answer: A. Stage II; ABVD × 2 cycles plus involved-site radiotherapy (ISRT)
Explanation
The histology describes nodular sclerosis classical Hodgkin lymphoma (NSCHL) — lacunar Reed-Sternberg variants, CD30+/CD15+/CD45−. Mediastinum plus one axilla = two nodal regions on the same side of diaphragm = Ann Arbor Stage II. For early-stage (I–II) favourable classical HL, current ESMO/GHSG guidelines recommend 2 cycles of ABVD followed by involved-site radiotherapy (ISRT 20 Gy). BV-AVD (ECHELON-1 trial benefit) is used for advanced-stage (III–IV) HL. R-CHOP is for B-cell lymphomas, not HL. Rituximab targets CD20, which is negative in HL.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.