Pyrexia, Weight Loss and a Painless Mass

🗒️ Question

A 28 year old woman presents with persistent fatigue, intermittent fevers and a painless mass in her left supraclavicular region that she first noticed 6 months ago. Over the past 3 weeks, she has experienced night sweats and unintentional weight loss. She reports occasional pruritus but denies any significant respiratory or gastrointestinal symptoms.

On examination, there is a 3 cm firm, non-tender lymph node in the left supraclavicular area. Chest X-ray demonstrates mediastinal widening. A lymph node biopsy shows a mixed inflammatory background with scattered large cells that are CD15 and CD30 positive.

Which of the following is the most likely diagnosis?

(A) Follicular lymphoma
(B) Hodgkin's lymphoma
(C) Anaplastic large cell lymphoma
(D) Diffuse large B-cell lymphoma
(E) Sarcoidosis