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Self-Assessment Questions

Oncology

Non-Hodgkin’s Lymphoma: Review Questions

Eric Jacobsen, MD

Dr. Jacobsen is an instructor in medicine, Harvard Medical School, Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.


Choose the single best answer for each question.

1. A 60-year-old woman presents with new, asymptomatic left axillary lymphadenopathy. A biopsy reveals follicular lymphoma. Staging computed tomography (CT) scans show multiple mediastinal, axillary, and mesenteric lymph nodes. The largest lymph nodes are 3 cm in diameter and are not compressing surrounding organs. A bone marrow biopsy and aspirate are consistent with follicular lymphoma involvement. She otherwise feels well and has no history of night sweats, fatigue, or weight loss. What is the most appropriate management option for this patient at this time?
  1. Close monitoring with repeat CT scans in 3 to 6 months
  2. Combination chemotherapy and monoclonal antibody therapy
  3. High-dose chemotherapy with stem cell transplantation
  4. Single-agent chemotherapy
  5. Total lymph node irradiation
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2. A 55-year-old man is referred to an oncologist with a longstanding history of gastroesophageal reflux disease. His symptoms have been refractory to proton pump inhibitors, and he underwent esophagogastroduodenoscopy, which revealed a 3-cm mass in the antrum. A biopsy demonstrated marginal zone mucosal-associated lymphoid tissue (MALT) lymphoma. Which of the following infectious agents should this physician test for?

  1. Campylobacter jejuni
  2. Extended spectrum ß-lactamase-producing Escherichia coli
  3. Progression to stage IV CLL with subsequent anemia from bone marrow replacement
  4. Giardia species
  5. Helicobacter pylori
  6. Salmonella species
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3. A 70-year-old man is referred for colonoscopy as part of an evaluation for mild iron deficiency anemia. The endoscopist notes numerous polyps throughout the colon. A preliminary biopsy report is consistent with lymphoma. What type of lymphoma is the most likely cause of this patient’s clinical syndrome?
  1. Burkitt’s lymphoma
  2. Diffuse large B-cell lymphoma
  3. Follicular lymphoma
  4. Mantle cell lymphoma
  5. Marginal zone lymphoma
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4. A 30-year-old man presents to the emergency department with a 2-week history of cervical lymphadenopathy, drenching night sweats, and unintentional weight loss of 15 lb. A CT scan shows diffuse, bulky lymphadenopathy in the neck, mediastinum, retroperitoneum, and iliac lymph nodes. Laboratory results reveal a blood urea nitrogen level of 56 mg/dL, serum creatinine level of 2.5 mg/dL, calcium level of 13 mg/dL, and a lactate dehydrogenase level 4 times the upper limit of normal. His complete blood count is normal except for a leukocyte count of 24.6 ×103/µL with 70% lymphocytes, some of which are atypical in appearance. He is originally from Jamaica and has no significant past medical history. He has had multiple female sexual partners but has never used intravenous drugs. Which virus is the most likely cause of this patient’s illness?

  1. Cytomegalovirus
  2. Dengue virus
  3. Epstein-Barr virus
  4. HIV
  5. Human T-lymphotrophic virus type 1 (HTLV-1)
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