A 67-year-old man with CLL develops sudden worsening of constitutional symptoms, rapid lymph node enlargement, and markedly elevated LDH. Biopsy reveals transformation to large B-cell lymphoma. This transformation is known as:

• A Accelerated phase progression
• B Blast crisis
• C Secondary follicular lymphoma
• D Richter transformation ✓

Explanation

Richter transformation (Richter syndrome) refers to the clonal evolution of CLL into an aggressive lymphoma, most commonly diffuse large B-cell lymphoma (DLBCL), in approximately 5–10% of CLL cases. It carries a poor prognosis with median survival of 6–12 months. Accelerated phase and blast crisis are terms used for CML progression. Follicular lymphoma does not arise from CLL transformation.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

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