Lymph Nodes, Spleen, Lymphomas and Multiple Myeloma for NEET PG Pathology: Hodgkin, Reed-Sternberg, Burkitt, Bence Jones

Start Here

🎯 Exam priority: Very high. Expect: a young adult with neck nodes and Reed-Sternberg cells, CD15/CD30, a child with a fast-growing lymphoma and t(8;14), an elderly man with back pain, high calcium and rouleaux, causes of massive splenomegaly, and caseating nodes.

CBME mapping: PA 19.1–19.6, 20.3.

Lymph Nodes and Spleen

• Lymphadenopathy: palpable nodes > 1 cm (> 2 cm in the groin); localized (one area) or generalized (≥ 2 areas). Generalized suggests systemic disease — infection (infectious mononucleosis), malignancy (lymphoma) or autoimmunity. Supraclavicular or epitrochlear nodes may herald cancer; cancer accounts for about 4% of unexplained nodes after age 40.

• Tuberculous lymphadenitis (scrofula) is the commonest extrapulmonary TB; granulomas with caseous necrotic centres.

• Splenomegaly: in the tropics, mostly infections (malaria, visceral leishmaniasis, schistosomiasis). Massive (> 8 cm below the costal margin): CLL, CML, Gaucher disease, hairy cell leukaemia, NHL, polycythaemia vera, primary myelofibrosis. A big spleen can cause cytopenias (hypersplenism).

Lymphomas and Myeloma

Hodgkin lymphoma, non-Hodgkin lymphoma and multiple myeloma compared. Drawn by TrackNation.

• Hodgkin: binucleated Reed-Sternberg cells (B-cell origin), CD15+, CD30+, CD20−; peaks 15–40 and > 60 years; EBV and HIV raise risk; painless nodes, fever, night sweats, weight loss, itching; pain in nodes after alcohol; spreads to contiguous nodes. Subtypes include nodular sclerosis (dense fibrosis around nodules) and mixed cellularity. Diagnosis by node biopsy; usually curable.

• Non-Hodgkin: may be extranodal (skin, gut, lung, CNS); risks include immunodeficiency, HIV, hepatitis C, HHV-8 and H. pylori. Burkitt: MYC (chromosome 8) translocated to the immunoglobulin heavy-chain locus on 14; EBV in the endemic form.

• Multiple myeloma: plasma-cell cancer making monoclonal immunoglobulin (M-protein); lytic bone lesions, kidney failure, high calcium, anaemia, infections; Bence Jones protein = free light chains in urine; rouleaux; ≥ 10% marrow plasma cells; punched-out lesions in about 80%. Test with serum protein electrophoresis and immunofixation.

Traps the Examiner Sets

• CD15 and CD30 positive, CD20 negative = Hodgkin (Reed-Sternberg).

• Hodgkin spreads to the next node group; NHL often appears outside nodes.

• Back pain + high calcium + kidney failure + anaemia in an older patient = myeloma.

• Massive spleen in India: also think of malaria and kala-azar.

Memory Hooks & Shortcuts

Shortcuts to lock in this article's numbers and lists. Each one only re-packages facts proven above.

• 🧠 Reed-Sternberg wears 15 and 30 (CD15, CD30) — Hodgkin markers

• 🧠 Hodgkin Hops to the next node — contiguous spread

• 🧠 Burkitt: 8 meets 14 (MYC) — t(8;14)

• 🧠 Myeloma CRAB: Calcium, Renal, Anaemia, Bone — plus infections

• 🧠 Bence Jones = light chains in urine — free kappa or lambda

• 🧠 Massive spleen: Cs and Gs (CLL, CML, Gaucher) + hairy cell, PV, PMF, NHL — massive splenomegaly

Rapid-Revision Cards

• Enlarged node

  > 1 cm (> 2 cm groin).

• Generalized nodes

  ≥ 2 areas: infection, lymphoma, autoimmune.

• Red-flag nodes

  Supraclavicular, epitrochlear.

• Scrofula

  Commonest extrapulmonary TB; caseating granulomas.

• Tropical splenomegaly

  Malaria, kala-azar, schistosomiasis.

• Massive spleen

  CLL, CML, Gaucher, hairy cell, NHL, PV, PMF.

• Hypersplenism

  Big spleen → cytopenias.

• Reed-Sternberg

  Binucleated, B-cell; CD15+, CD30+, CD20−.

• Hodgkin ages

  15–40 and > 60.

• Hodgkin clues

  B symptoms, itching, alcohol pain, contiguous spread.

• Nodular sclerosis

  Dense fibrous tissue around nodules.

• NHL

  Extranodal; HIV, HCV, HHV-8, H. pylori.

• Burkitt

  MYC t(8;14); EBV endemic.

• Myeloma

  M-protein; lytic bones, kidney, calcium, anaemia, infections.

• Myeloma marrow

  ≥ 10% clonal plasma cells.

• Bence Jones

  Urinary free light chains.

• Rouleaux

  Stacks of 3–12 red cells.

Sources

Facts in this article were checked against these documents.

• MSD Manual Professional: Lymphadenopathy; Tuberculosis; Splenomegaly; Hodgkin Lymphoma; Non-Hodgkin Lymphomas; Burkitt Lymphoma; Multiple Myeloma — Merck & Co. (MSD Manuals), reviewed 2025–2026 (link)

• Competency Based Undergraduate Curriculum, Pathology (PA 19, 20.3) — National Medical Commission, 2024

Test Yourself: Practice Questions

Twenty-six questions in NEET PG style, most of them clinical vignettes.

Practice Questions (NEET PG pattern)

Original questions written in the style of the exam: +4 for a correct answer, −1 for a wrong one. Every answer was checked against the sources listed above. NEET PG papers are not published by NBEMS, so these are not past-paper questions.

Q1. A 24-year-old has painless neck nodes, night sweats and itching; biopsy shows large binucleated cells that are CD15+, CD30+, CD20−. The diagnosis is

• (a) tuberculous lymphadenitis

• (b) Hodgkin lymphoma

• (c) Burkitt lymphoma

• (d) CLL

Q2. Reed-Sternberg cells are of

• (a) plasma-cell origin

• (b) macrophage origin

• (c) T-cell origin

• (d) B-cell origin

Q3. A patient with lymphoma notices pain in his enlarged nodes after drinking alcohol. This rare clue suggests

• (a) multiple myeloma

• (b) CML

• (c) Hodgkin lymphoma

• (d) sarcoidosis

Q4. Hodgkin lymphoma typically spreads

• (a) randomly to distant extranodal sites first

• (b) to contiguous node groups

• (c) never beyond one node

• (d) only to bone

Q5. The age pattern of Hodgkin lymphoma is

• (a) constant at all ages

• (b) only in children under 5

• (c) commonest at 15–40 years with a second peak after 60

• (d) only after 70

Q6. A node biopsy shows nodules of Hodgkin tissue surrounded by dense fibrous tissue. The subtype is

• (a) lymphocyte-depleted

• (b) mixed cellularity

• (c) nodular sclerosis

• (d) lymphocyte-rich

Q7. A 7-year-old has a rapidly growing lymphoma; cytogenetics shows MYC on chromosome 8 translocated to the immunoglobulin heavy-chain locus on 14. The diagnosis is

• (a) Burkitt lymphoma

• (b) CML

• (c) Hodgkin lymphoma

• (d) ALL

Q8. Endemic Burkitt lymphoma is closely associated with

• (a) Epstein-Barr virus

• (b) HTLV-1

• (c) hepatitis B

• (d) HPV

Q9. Which infection increases the risk of a gastric (extranodal) lymphoma?

• (a) Giardia

• (b) Helicobacter pylori

• (c) Streptococcus pyogenes

• (d) Candida

Q10. A 68-year-old has back pain, anaemia, raised calcium and creatinine; the smear shows rouleaux. The diagnosis is

• (a) multiple myeloma

• (b) metastatic prostate cancer only

• (c) Hodgkin lymphoma

• (d) CLL

Q11. Rouleaux on a peripheral smear are

• (a) fragmented red cells

• (b) stacks of 3–12 red cells (myeloma)

• (c) red cells with central dots

• (d) clumped platelets

Q12. Bence Jones protein in myeloma is

• (a) heavy chains in serum

• (b) albumin

• (c) haemoglobin in urine

• (d) free monoclonal light chains in the urine

Q13. Myeloma is diagnosed on marrow when clonal plasma cells are at least

• (a) 50%

• (b) 2%

• (c) 90%

• (d) 10%

Q14. A skull X-ray of a myeloma patient shows

• (a) punched-out lytic lesions (about 80% have lytic lesions or osteoporosis)

• (b) hair-on-end appearance only

• (c) sun-ray trabeculae

• (d) sclerotic metastases

Q15. The first laboratory test to detect an M-protein is

• (a) Hb electrophoresis

• (b) bone marrow biopsy

• (c) skeletal survey

• (d) serum protein electrophoresis with immunofixation

Q16. A spleen palpable 10 cm below the costal margin in a 60-year-old with a very high WBC count suggests

• (a) infectious mononucleosis

• (b) CML (a cause of massive splenomegaly)

• (c) iron deficiency

• (d) viral hepatitis

Q17. In the tropics, splenomegaly is most often caused by

• (a) infections such as malaria, visceral leishmaniasis and schistosomiasis

• (b) hairy cell leukaemia

• (c) thalassaemia trait

• (d) Gaucher disease

Q18. A patient with a large spleen has low platelets and white cells with a normal marrow. This is

• (a) leukaemia

• (b) aplastic anaemia

• (c) megaloblastic anaemia

• (d) hypersplenism

Q19. A young man from India has enlarged cervical nodes; biopsy shows epithelioid granulomas with caseous centres. The diagnosis is

• (a) sarcoidosis only

• (b) Burkitt lymphoma

• (c) tuberculous lymphadenitis (scrofula)

• (d) Hodgkin lymphoma

Q20. Lymph nodes are considered enlarged when they exceed

• (a) 1 cm (2 cm in the groin)

• (b) 5 cm

• (c) 0.2 cm

• (d) 3 cm everywhere

Q21. An isolated enlarged left supraclavicular node in a 55-year-old is concerning because it

• (a) may herald cancer

• (b) is normal at that age

• (c) is always reactive

• (d) means TB only

Q22. Lymphadenopathy in two or more body areas is called

• (a) generalized, suggesting systemic disease

• (b) localized

• (c) normal

• (d) reactive only

Q23. Hodgkin lymphoma risk is increased by infection with

• (a) EBV or HIV

• (b) hepatitis A

• (c) rotavirus

• (d) HPV

Q24. Hodgkin lymphoma is diagnosed by

• (a) lymph node biopsy

• (b) SPEP

• (c) blood smear alone

• (d) bone scan

Q25. A child in Africa has a tumour of the jaw; biopsy shows a lymphoma with a MYC translocation. This is

• (a) endemic Burkitt lymphoma

• (b) Hodgkin lymphoma

• (c) CLL

• (d) multiple myeloma

Q26. In sporadic (non-endemic) Burkitt lymphoma, the commonest presentation is

• (a) an abdominal mass, often near the ileocaecal valve

• (b) lytic bone lesions

• (c) isolated skin lesions

• (d) a jaw tumour

Active Recall

From memory: define lymphadenopathy and its red flags, describe tuberculous lymphadenitis, list causes of tropical and massive splenomegaly, contrast Hodgkin and non-Hodgkin lymphoma (cells, markers, spread, risks), give the Burkitt translocation, and list the features and diagnostic criteria of multiple myeloma.