The most common subtype of Non-Hodgkin's lymphoma in India is:

Diffuse small cell lymphocytic lymphoma

A 32-year-old female presents with a 2-month history of progressive, painless swelling in the left side of her neck. She also reports low-grade fever, night sweats, and unintentional weight loss. Physical examination reveals a firm, non-tender, immobile mass in the left cervical region, and multiple smaller lymph nodes in the supraclavicular area. Chest X-ray shows mediastinal widening, and a lymph node biopsy confirms the presence of Reed-Sternberg cells. What is the most appropriate management for this patient?

Hodgkin Lymphoma with the ABVD regimen

NHL with a highly aggressive chemotherapy regimen

Hodgkin Lymphoma with surgical excision only

Hodgkin Lymphoma with radiation therapy only

Which of the following is the most common hematologic malignancy associated with Neurofibromatosis-1 (NF-1) in a child?

Juvenile Myelomonocytic Leukemia (JMML)

Acute Lymphoblastic Leukemia (ALL)

Which of the following statements on lymphoma is not true?

In general, follicular (nodular) NHL has worse prognosis compared to diffuse NHL.

HD more often tends to remain localized to a single group of lymph nodes and spreads by contiguity.

Several types of non-Hodgkin's lymphoma (NHL) may have a leukemic phase.

A single classification system for Hodgkin's disease (HD) is almost universally accepted.

A 12-year-old boy comes to the physician because of headache, fever, nausea and vomiting. His mother reports that he has been unwell for a couple of days but seems to have become worse. In addition to his headache, he has a very stiff neck. He has no other past medical history except for well-controlled asthma. His pulse is 114/min and he has a fever of 38.5°C (101.3°F). His examination is notable for meningismus, as evidenced by discomfort elicited by movement of his neck. He also becomes visibly uncomfortable when you check his pupillary responses with a flashlight. Which of the following patterns of cerebrospinal fluid would you expect to see if this boy turns out to have viral meningitis?

Normal opening pressure; Elevated cell count; Elevated protein; Normal glucose

Normal opening pressure; Elevated cell count; Elevated protein; Low glucose

Elevated opening pressure; Normal cell count; Normal protein; Normal glucose

Elevated opening pressure; Elevated cell count; Elevated protein; Low glucose

A child presents with fever and vesicular lesions on the upper limb and the lower limb. Neck stiffness was present. Similar lesions were present on the palms, soles, and oral cavity. CSF analysis revealed normal glucose levels and elevated lymphocytes and protein. What is the most likely diagnosis?

Coxsackie viral meningitis and Hand Foot Mouth disease

Bacterial meningitis with sepsis

Herpes simplex gingivostomatitis and meningoencephalitis

Lymphomas for UPSC-CMS: High-Yield Pediatrics Lessons

Lymphoma Basics - Tiny Tumors, Big Trouble

Malignant neoplasms of lymphocytes or their precursors, typically arising in lymphoid tissues.
Two major categories: Hodgkin Lymphoma (HL) and Non-Hodgkin Lymphoma (NHL).
HL: Characterized by presence of Reed-Sternberg (RS) cells; often localized, contiguous spread.
NHL: More common, diverse group of B-cell, T-cell, NK-cell origin; often disseminated.
Staging: Ann Arbor classification (Stages I-IV, with A/B symptoms).

⭐ Hodgkin Lymphoma classically presents with a bimodal age distribution, peaking at 15-35 years and again at >50 years anco

Hodgkin's Lymphoma - Reed's Rogue Roster

⭐ Reed-Sternberg (RS) cells are pathognomonic, appearing as large cells with bilobed or multiple nuclei and prominent eosinophilic nucleoli ("owl-eye" appearance).

Age: Bimodal distribution (15-35 years and >50 years).
Presentation: Painless lymphadenopathy (often cervical/supraclavicular), contiguous spread. "B" symptoms: unexplained fever, drenching night sweats, weight loss >10% over 6 months.
📌 RS Cell "Rogues": Owl eyes, With Lacunar variants (Nodular Sclerosis type), CD30 & CD15 positive.
Key Subtypes:
- Nodular Sclerosis (most common, young females, good prognosis)
- Mixed Cellularity (EBV association, intermediate prognosis)
- Lymphocyte-Rich (best prognosis)
- Lymphocyte-Depleted (worst prognosis, HIV association)

Reed-Sternberg cells in Hodgkin's Lymphoma

Non-Hodgkin's Lymphoma - Nasty Network Nuisance

Aggressive lymphoid malignancies, commoner than HL in kids. Often extranodal.
Key Subtypes & Features:
- Burkitt Lymphoma (BL):
  - Aggressive B-cell. Endemic (jaw, EBV) & Sporadic (abdomen).
  - Histology: "Starry sky" appearance.
  - Genetics: t(8;14) translocation involving MYC gene.
  ⭐ Burkitt Lymphoma is the fastest growing human tumor and associated with t(8;14).
- Lymphoblastic Lymphoma (LBL):
  - Mostly T-cell (85-90%).
  - Mediastinal mass (SVC risk), LAD. Can → ALL.
- Diffuse Large B-cell Lymphoma (DLBCL):
  - Aggressive B-cell type.
- Anaplastic Large Cell Lymphoma (ALCL):
  - ALK+ (t(2;5)). Nodes, skin, bone. 'Hallmark' cells.
Clinical Presentation: Rapid mass (abdomen, mediastinum, H&N), LAD. B-symptoms < HL. Emergencies (SVC, TLS) common.
Diagnosis & Management:

📌 Tx: CHOP-like chemo + Rituximab (B-cell). CNS prophylaxis vital.

Clues & Confirmation - Spotting Sneaky Cells

Clinical Suspicion:
- Painless, firm lymphadenopathy (rubbery, matted).
- B-symptoms: Fever (>38°C), drenching night sweats, weight loss (>10%/6mo). 📌 "B" for Bad prognosis.
- Mediastinal mass (HL, T-LBL): cough, dyspnea.
- Abdominal symptoms (Burkitt): pain, mass.
Diagnostic Workup:
- Labs: CBC, ESR, LDH (↑), Uric acid.
- Imaging: CXR, CT (staging), PET-CT (FDG-avid).
- Biopsy is KEY:
  
  ⭐ Excisional lymph node biopsy is crucial for accurate diagnosis and subtyping.
- Bone marrow & CSF analysis (staging, high-risk NHL).
- HPE & IHC:
  - HL: Reed-Sternberg cells (CD30+, CD15+).
  - NHL: Specific markers (e.g., Burkitt: t(8;14), Starry sky; Lymphoblastic: TdT+).

High‑Yield Points - ⚡ Biggest Takeaways

Hodgkin Lymphoma (HL): Reed-Sternberg cells are pathognomonic. Nodular Sclerosis is the most common subtype. Presents with painless lymphadenopathy.

Non-Hodgkin Lymphoma (NHL): More common, aggressive. Key types: Burkitt (t(8;14), starry sky, abdominal/jaw mass) & Lymphoblastic (mediastinal mass).

B symptoms (fever, night sweats, weight loss) are important prognostic factors, especially in HL.

Ann Arbor staging for HL. NHL often has extranodal involvement and rapid dissemination.

Chemotherapy is the primary treatment; radiotherapy is used cautiously to minimize late effects.

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Lymphomas