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

Source: https://tracknation.in/story/lymph-nodes-spleen-lymphomas-and-multiple-myeloma-for-neet-pg-pathology-hodgkin-reed-sternberg-burkitt-bence-jones (TrackNation — free UPSC notes with PYQs)

> NEET PG Pathology: lymphadenopathy and its red flags, tuberculous lymphadenitis, causes of splenomegaly, Hodgkin lymphoma (Reed-Sternberg cells, CD15/CD30, subtypes), non-Hodgkin and Burkitt lymphoma, and multiple myeloma (M-protein, Bence Jones, lytic lesions, rouleaux), with a diagram, hooks, vignette MCQs and cards.

## 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

- > 1 cm (> 2 cm groin).

- ≥ 2 areas: infection, lymphoma, autoimmune.

- Supraclavicular, epitrochlear.

- Commonest extrapulmonary TB; caseating granulomas.

- Malaria, kala-azar, schistosomiasis.

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

- Big spleen → cytopenias.

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

- 15–40 and > 60.

- B symptoms, itching, alcohol pain, contiguous spread.

- Dense fibrous tissue around nodules.

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

- MYC t(8;14); EBV endemic.

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

- ≥ 10% clonal plasma cells.

- Urinary free light chains.

- 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

**Answer: (b)** — Reed-Sternberg cells.

**Q2.** Reed-Sternberg cells are of

- (a) plasma-cell origin

- (b) macrophage origin

- (c) T-cell origin

- (d) B-cell origin

**Answer: (d)** — MSD.

**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

**Answer: (c)** — MSD.

**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

**Answer: (b)** — Unlike NHL, which often involves extranodal sites.

**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

**Answer: (c)** — Rare before age 10.

**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

**Answer: (c)** — MSD subtype table.

**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

**Answer: (a)** — Endemic form linked to EBV.

**Q8.** Endemic Burkitt lymphoma is closely associated with

- (a) Epstein-Barr virus

- (b) HTLV-1

- (c) hepatitis B

- (d) HPV

**Answer: (a)** — MSD.

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

- (a) Giardia

- (b) Helicobacter pylori

- (c) Streptococcus pyogenes

- (d) Candida

**Answer: (b)** — MSD NHL page.

**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

**Answer: (a)** — Lytic lesions, kidney failure, hypercalcaemia, anaemia, infections.

**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

**Answer: (b)** — MSD.

**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

**Answer: (d)** — 40% of IgG/IgA myeloma also have Bence Jones proteinuria.

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

- (a) 50%

- (b) 2%

- (c) 90%

- (d) 10%

**Answer: (d)** — Marrow involvement is patchy.

**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

**Answer: (a)** — MSD.

**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

**Answer: (d)** — MSD.

**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

**Answer: (b)** — Massive: CLL, CML, Gaucher, hairy cell, NHL, PV, myelofibrosis.

**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

**Answer: (a)** — MSD.

**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

**Answer: (d)** — Splenomegaly can cause cytopenias.

**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

**Answer: (c)** — Commonest extrapulmonary TB.

**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

**Answer: (a)** — MSD.

**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

**Answer: (a)** — Supraclavicular and epitrochlear nodes may herald cancer.

**Q22.** Lymphadenopathy in two or more body areas is called

- (a) generalized, suggesting systemic disease

- (b) localized

- (c) normal

- (d) reactive only

**Answer: (a)** — Infection, malignancy or autoimmunity.

**Q23.** Hodgkin lymphoma risk is increased by infection with

- (a) EBV or HIV

- (b) hepatitis A

- (c) rotavirus

- (d) HPV

**Answer: (a)** — MSD.

**Q24.** Hodgkin lymphoma is diagnosed by

- (a) lymph node biopsy

- (b) SPEP

- (c) blood smear alone

- (d) bone scan

**Answer: (a)** — Treatment is curative in most cases.

**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

**Answer: (a)** — The endemic African form often involves the jaw or facial bones and is linked to EBV.

**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

**Answer: (a)** — May cause bowel obstruction.

### 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.