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1. Lymphoma

The low power views show irregular fibroinflammatory nodules with central necrosis and an associated polymorphous cellular infiltrate consisting of small lymphocytes, histiocytes and plasma cells. Figure 3, panel D also shows some cells are Epstein-Barr virus positive.

Higher power views show large atypical cells including Reed-Sternberg cells against a background of lymphocytes. Reed–Sternberg cells are large and are either multinucleated or have a bilobed nucleus (thus resembling an "owl's eye" appearance) with prominent eosinophilic inclusion-like nucleoli. Reed–Sternberg cells are CD30 and CD15 positive.

The final pathology diagnosis was an atypical lymphohistiocytic infiltrate with necrosis best classified as EBV-positive immunodeficiency-associated lymphoproliferative disorder with Hodgkin lymphoma-like features.

What is the treatment for this type of lymphoma?

  1. Mechlorethamine plus vincristine plus procarbazine plus prednisone (MOPP)
  2. Doxorubicin plus bleomycin plus vinblastine plus dacarbazine (ABVD)
  3. Radiation therapy with 25 Gy to 30 Gy to clinically uninvolved sites and 35 Gy to 44 Gy to regions of initial nodal involvement
  4. Both MOPP and radiation therapy
  5. Stop methotrexate

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