90 clinical-vignette questions in three levels: 30 basics, 30 applied and innovative, and 30 challenging (26 Diagnosis, 50 Treatment, 14 Survivorship; 6 built on schematic imaging, endoscopy or histology drawings). Practise question by question with instant marking, or take a timed mock test with a result summary by topic, level and section. You can also print the page as a booklet.
Core facts for NEET-PG and USMLE Step 1–2: histology, risk factors, presentation, staging and first-line principles.
Which lymph node region is most often enlarged when classic Hodgkin lymphoma (cHL) presents?
Answer: B. Neck or supraclavicular nodes are enlarged in 60–80% of patients; axillary nodes in about 30% and inguinal nodes in about 10%. Disease confined below the diaphragm is uncommon (under 10%).
Review: section 02
Which of the following counts as a "B symptom" in Hodgkin lymphoma?
Answer: E. B symptoms are unexplained fever above 38°C, drenching night sweats, and loss of more than 10% of body weight in 6 months. Itch, alcohol-induced pain and fatigue are real clues but are not B symptoms.
Review: section 02
A 23-year-old notices that a neck lump aches within minutes of drinking alcohol. Which statement is correct?
Answer: E. Alcohol-associated pain occurs in under 10% of patients and has no prognostic weight, but it is very specific for cHL. It is not a B symptom.
Review: section 02
Which lymph node is most likely to need a biopsy rather than watching?
Answer: A. Persistence beyond about 4 weeks, size over about 2 cm, a firm rubbery feel, growth, and a supraclavicular site all favour biopsy. Tender nodes with an obvious infection that settle within weeks are reactive.
Review: section 02
What is the preferred way to diagnose suspected Hodgkin lymphoma in an enlarged neck node?
Answer: B. Excision gives the architecture and enough tissue for immunostains and subtyping; several core biopsies can suffice when excision is not possible. FNAC cannot make or exclude the diagnosis.
Review: section 03
This schematic H&E section from an excised neck node shows the large cell marked in the centre. What is it?
Answer: D. The classic Reed-Sternberg cell has two mirror-image nuclei with large eosinophilic nucleoli, set in a mixed background of small lymphocytes, eosinophils and histiocytes. Popcorn cells belong to NLPHL; Langhans cells to granulomas.
Review: section 03
Which immunophenotype is typical of Hodgkin/Reed-Sternberg (HRS) cells in classic HL?
Answer: B. HRS cells express CD30 (virtually all) and usually CD15 (75–85%), and lack CD45 and CD3. B-cell markers are absent or weak; PAX5 is weakly positive. CD20+, CD45+, CD30− describes the LP cells of NLPHL.
Review: section 03
In the Indian OncoCollect registry of 939 patients, which subtype of classic HL was commonest?
Answer: D. Mixed cellularity made up about 61% and nodular sclerosis about 27% of Indian cases, the reverse of the Western pattern (nodular sclerosis about 70%). Mixed cellularity is closely linked with EBV.
Review: section 01
Which virus is most closely linked with classic Hodgkin lymphoma?
Answer: C. EBV is found in about 70% of mixed cellularity, over 90% of lymphocyte-depleted and nearly all HIV-associated cHL, and in nearly all cases in tropical regions. The absolute risk of cHL after infectious mononucleosis is only about 1 in 1000.
Review: section 01
Which staging system is used for Hodgkin lymphoma?
Answer: B. Lugano staging (from Ann Arbor with the Cotswolds modifications) uses PET-CT and records stage I–IV, A or B, the size of any bulky mass and E for limited extranodal extension.
Review: section 03
PET-CT shows involved cervical and para-aortic nodes, no organ involvement and no B symptoms. What is the Lugano stage?
Answer: E. Nodal regions on both sides of the diaphragm make it stage III. The spleen also counts as nodal (lymphoid) tissue for staging.
Review: section 03
This schematic chest X-ray is from a 24-year-old with cough. The anterior mediastinal mass is wider than one-third of the thoracic diameter. How is this recorded?
Answer: C. A mediastinal mass over one-third of the internal thoracic diameter (or any mass of 10 cm or more) is bulky. In stage I–II it makes the disease unfavourable; it does not by itself change the stage.
Review: section 03
When is a bone marrow biopsy needed in staging classic HL?
Answer: E. PET-CT detects marrow involvement well, so routine marrow biopsy has been dropped. Homogeneous marrow uptake on PET is usually reactive.
Review: section 03
An interim PET after two cycles shows residual uptake above the mediastinal blood pool but not above the liver. What is the Deauville score and its meaning?
Answer: A. Deauville 1–3 counts as complete metabolic response; 4 (moderately above liver) and 5 (markedly above liver or new lesions) do not.
Review: section 03
What does ABVD stand for?
Answer: A. ABVD is the backbone for early-stage cHL. AVD is the same regimen without bleomycin.
Review: section 06
Which pair of baseline tests is needed before starting ABVD?
Answer: E. Doxorubicin needs an adequate ejection fraction (generally 50% or more) and bleomycin a DLCO of generally 60% or more. HBV, HCV and HIV tests and fertility counselling are also done before treatment.
Review: section 06
In the S1826 trial, which regimen became the preferred first-line treatment for stage III–IV classic HL?
Answer: E. N-AVD gave 2-year PFS of 92% vs 83% with BV-AVD, with less toxicity, in patients aged 12 and over.
Review: section 06
Which drug targets CD30 on Hodgkin/Reed-Sternberg cells?
Answer: D. Brentuximab vedotin is an anti-CD30 antibody carrying a microtubule poison. Polatuzumab vedotin targets CD79b, rituximab CD20, nivolumab PD-1 and daratumumab CD38.
Review: section 06
Why are PD-1 inhibitors such as nivolumab so active in classic HL?
Answer: C. 9p24.1 gain increases PD-L1, PD-L2 and JAK2. The PD-1 ligands switch off the T cells around the HRS cells; anti-PD-1 antibodies release them.
Review: section 04
Which radiotherapy approach is used for Hodgkin lymphoma today?
Answer: A. Small involved-site fields and lower doses replaced the old mantle and extended fields, which caused most of the heart disease and breast cancer seen in long-term survivors.
Review: section 05
During PET-adapted treatment of early-stage cHL, what guides the decision to de-escalate (drop RT or bleomycin) or escalate?
Answer: E. Interim PET (PET2) is the single most important guide: a negative scan allows de-escalation, a positive scan prompts more treatment or a biopsy.
Review: section 06
In which patient is bleomycin best avoided?
Answer: A. Bleomycin lung toxicity is commoner and more dangerous in older people, smokers, those with kidney impairment or low DLCO. Over 60, bleomycin is avoided.
Review: section 06
A patient on ABVD has a neutrophil count of 0.8 × 10⁹/L on the day of cycle 2 but is well and afebrile. What is the usual practice?
Answer: B. ABVD is given on schedule regardless of the neutrophil count, without dose cuts; full dose intensity is achievable without growth factor. G-CSF is reserved for patients who had febrile neutropenia or infection.
Review: section 06
Which drug is part of treatment for nodular lymphocyte-predominant HL (NLPHL) but not for classic HL?
Answer: B. NLPHL cells are CD20-positive, so rituximab-based treatment (R-CHOP, R-CVbP, R-B or rituximab alone) is used when systemic therapy is needed.
Review: section 06
What is the curative standard for a fit patient whose classic HL relapses after first-line chemotherapy?
Answer: A. Salvage to a complete metabolic response followed by autologous transplant cures more than half of relapsed patients. Checkpoint-inhibitor-based salvage gives the most complete responses.
Review: section 06
What is the leading cause of death in long-term survivors of Hodgkin lymphoma?
Answer: C. Second cancers lead, and cardiovascular disease is the leading non-cancer cause of death. Most deaths in the first 5–10 years are from relapse.
Review: section 08
Which blood test should be done every year after radiotherapy to the neck?
Answer: C. Thyroid dysfunction develops in 30–60% after neck radiotherapy, mostly within 5 years, so TSH is checked yearly for life.
Review: section 08
A woman had chest radiotherapy for HL at age 18. When should breast screening start?
Answer: B. Women who had chest RT between 10 and 30 years of age have a markedly higher breast cancer risk and are screened early: a yearly mammogram, with MRI considered in addition.
Review: section 08
A patient is in complete remission 18 months after treatment and feels well. Which follow-up is recommended?
Answer: C. Routine surveillance PET or CT rarely finds relapse before symptoms do and adds radiation. Visits every 3–6 months in years 1–2, then every 6–12 months to year 3, then yearly.
Review: section 08
A 24-year-old man asks about fertility before ABVD. What is the best advice?
Answer: C. ABVD rarely causes lasting infertility, unlike alkylator-based regimens (BEACOPP-type) and transplant conditioning. Sperm banking is offered because treatment may later need to intensify.
Review: section 08
Clinical reasoning: calculations (pack-years, predicted lung function, NNT), CT and fluid findings, reading trial results, sequencing traps.
A 50-year-old man has stage IV cHL. Albumin 3.6 g/dL, Hb 11.0 g/dL, WBC 16,000/µL, lymphocytes 900/µL. What is his International Prognostic Score (IPS)?
Answer: C. One point each: age over 45, male, stage IV, albumin under 4 g/dL, WBC 15,000 or more, and lymphocytes under 600 or under 8% of WBC (900/16,000 = 5.6%). Hb is not under 10.5 g/dL, so it scores 0. Total 6.
Review: section 03
A 26-year-old woman has stage IIA cHL in three nodal regions above the diaphragm, ESR 22, no bulk. PET2 after two ABVD is Deauville 2. Is "2 ABVD + 20 Gy and stop" appropriate?
Answer: B. The 2 ABVD + 20 Gy approach (HD16) applies only when every GHSG favourable criterion is met, including no more than two nodal regions. EORTC and NCCN allow up to three regions; she follows the chemotherapy-only (ABVD × 2 more) or CMT (ABVD × 1 + 30 Gy) pathway.
Review: section 06
A 30-year-old has left cervical and mediastinal nodes, and the mediastinal mass invades the adjacent sternum. No other organs are involved and there are no B symptoms. What is the stage?
Answer: B. Two regions on the same side of the diaphragm (stage II) with limited contiguous extension into a neighbouring organ (E). Diffuse or non-contiguous organ involvement would be stage IV.
Review: section 03
This schematic interim PET is from a 29-year-old with early favourable cHL after two cycles of ABVD. A single mediastinal site is moderately hotter than the liver. What next?
Answer: C. This is Deauville 4 at one site. Two more ABVD and PET4: Deauville 1–3 → 30 Gy; 4–5 → biopsy before calling it refractory. Multiple Deauville 4 sites or any Deauville 5 at PET2 need a biopsy first.
Review: section 06
A 22-year-old took anti-TB treatment for 3 months for a neck node after FNAC reported "granulomatous lymphadenitis". The node is now 4 cm and he has night sweats. What next?
Answer: D. Send the node for histology, immunostains, mycobacterial culture and molecular TB tests. About 15% of cHL nodes contain granulomas, so a granuloma on a small sample does not exclude lymphoma. In Indian series, 16% of adults and 29% of children had anti-TB treatment before HL was diagnosed.
Review: section 02
A 19-year-old has a 12 cm anterior mediastinal mass and no enlarged peripheral nodes. Which is the best route to a diagnosis?
Answer: E. Thin-needle and endobronchial samples are often too small or crushed to separate cHL from primary mediastinal B-cell lymphoma, grey-zone lymphoma or thymic tumours. Large mediastinal masses can compress the airway under general anaesthesia.
Review: section 03
This schematic immunostain of a node biopsy shows large cells with membrane staining and a dot of staining near the nucleus. Which marker is this, and which drug targets it?
Answer: C. CD30 in HRS cells typically gives membrane and Golgi (paranuclear dot) staining. Brentuximab vedotin is the anti-CD30 antibody-drug conjugate used in BV-AVD, BrECADD, salvage and maintenance.
Review: section 03
This schematic PET image shows abnormal uptake in the left neck, the mediastinum and diffusely in the spleen. What is the stage?
Answer: A. For lymphoma staging, the spleen is lymphoid tissue. Involvement on both sides of the diaphragm is stage III; liver, lung, marrow or bone spread would be stage IV.
Review: section 03
A 40-year-old man has EBER-positive mixed cellularity cHL with weight loss and non-contiguous spread to the liver and marrow. Which test is most important to add?
Answer: D. cHL in people living with HIV is almost always EBV-positive, often mixed cellularity or lymphocyte-depleted, and more often advanced with unusual spread. HIV testing is part of every work-up.
Review: section 04
In H10F (early favourable, PET2-negative), combined modality therapy gave 10-year PFS 98.8% vs 85.4% with chemotherapy alone, and overall survival 100% vs 98%. What is the correct interpretation?
Answer: A. Either approach is acceptable: relapses after chemotherapy alone are usually salvaged, so survival is similar. The choice weighs relapse risk against late effects of RT (breast, heart, lung) and patient preference.
Review: section 06
In S1826, 2-year PFS was 92% with N-AVD and 83% with BV-AVD. Approximately how many patients must be treated with N-AVD instead of BV-AVD to prevent one progression or death at 2 years?
A 45-year-old with stage IIIB cHL has rheumatoid arthritis that needs methotrexate. Which first-line regimen fits best?
Answer: A. N-AVD is contraindicated in autoimmune disease that needs immunosuppression. For patients up to about 60, BV-AVD with mandatory G-CSF is the alternative; RATHL is an option when neither is suitable.
Review: section 06
A fit 68-year-old with stage IVB cHL and no autoimmune disease asks about treatment. Which plan is preferred?
Answer: E. Add a geriatric assessment and early review of fever. In the S1826 older subgroup, N-AVD gave 2-year PFS 89% vs 64% over BV-AVD. Bleomycin is avoided over 60 (E2496: 9% treatment deaths). Sequential BV → AVD → BV is the alternative.
Review: section 06
A 32-year-old with stage IIIA cHL is treated with ABVD because immunotherapy is unaffordable. PET2 is Deauville 2. What next (RATHL approach)?
Answer: D. In RATHL, omitting bleomycin after a negative PET2 gave the same outcomes with less lung toxicity (7-year PFS about 80%, OS 93%).
Review: section 06
A 27-year-old with stage IIIB cHL had a 9 cm nodal mass at diagnosis and is in complete metabolic response after chemotherapy. Is consolidation radiotherapy to the former bulky site needed?
Answer: B. In HD0607, RT to masses of 5–7, 8–10 or over 10 cm made no PFS difference after a complete metabolic response to ABVD. RT is kept for a single PET-positive residual site.
Review: section 05
A 22-year-old woman has early-stage cHL in the mediastinum and both axillae; PET2 is negative. Which approach do most experts favour?
Answer: A. Young women whose breasts would lie in the field, and patients with two or three thoracic sites, lean towards chemotherapy only. Neck-only disease makes CMT easier.
Review: section 05
A district hospital cannot arrange interim PET. A 30-year-old has early favourable (non-GHSG-favourable) cHL. What is the recommended plan?
Answer: D. When the response cannot be measured, combined modality therapy is preferred over chemotherapy alone because relapses cannot be predicted. GHSG-favourable patients can have ABVD × 2 + 20 Gy.
Review: section 06
A fit 35-year-old has stage IIB cHL with a large mediastinal mass and an extranodal lesion, and wants the shortest effective treatment. Which regimen was tested in exactly this group?
Answer: E. HD21 enrolled adults up to 60 with stage III–IV or stage IIB with a large mediastinal mass or extranodal lesions; PET2-negative patients needed only 4 cycles. Expect febrile neutropenia (28%) and transfusions.
Review: section 06
A 28-year-old relapses 8 months after completing ABVD-AVD for stage IIIB cHL. PET shows new nodes. What is the first step?
Answer: C. Grey-zone lymphoma, another cancer, infection or sarcoidosis can mimic relapse. After confirmation: checkpoint-based salvage, PET complete response, then autologous transplant.
Review: section 06
Which patient should be offered brentuximab vedotin maintenance after autologous transplant?
Answer: B. AETHERA: in BV-naive patients with a high-risk feature (primary refractory or relapse within 12 months, less than complete response to salvage, B symptoms or extranodal disease at relapse, two or more salvage lines), 5-year PFS was 59% vs 41%.
Review: section 06
Six weeks into nivolumab-based salvage, a well patient's PET shows larger, avid nodes. What is the best course?
Answer: B. Checkpoint inhibitors can cause pseudoprogression and sarcoid-like reactions. A biopsy settles it when doubt persists.
Review: section 06
A 33-year-old has stage IA NLPHL in a single cervical node (LP-IPS 0). What is the usual treatment for an adult?
Answer: E. For stage IA or contiguous IIA NLPHL, involved-site RT (30–36 Gy) gives better control than watching or rituximab alone. Watching is reasonable after complete excision if the patient prefers.
Review: section 06
A 26-year-old is 12 weeks pregnant with asymptomatic, non-bulky stage IIA cHL. What is the usual plan?
Answer: D. Stable disease in the first trimester is watched until organogenesis is complete. In the second and third trimesters ABVD can be given (AVD if more than two cycles), avoiding chemotherapy in the 3 weeks before delivery.
Review: section 06
How should cHL be staged in a pregnant woman?
Answer: A. PET-CT is avoided during pregnancy; MRI and ultrasound stage the disease, and PET is done soon after delivery to guide the rest of treatment.
Review: section 06
A 14-year-old has stage IIIB cHL. Which first-line regimen is suggested?
Answer: B. High-risk (stage III–IV) disease in adolescents: N-AVD (adolescent 2-year PFS 95% vs 83% with BV-AVD). BV-AVE-PC or BV-AVD are alternatives when nivolumab cannot be used.
Review: section 06
Why is a yearly blood count advised for years after treatment of Hodgkin lymphoma?
Answer: A. Therapy-related AML and MDS peak 5–9 years after alkylating agents and are very rare after ABVD; a CBC at visits is simple surveillance.
Review: section 08
In a Dutch case-control study, how did the risk of valve disease change with radiation dose to the heart valves?
Answer: D. The relative risks were 1.4, 3.1, 5.4 and 11.8 for ≤30, 31–35, 35–40 and ≥40 Gy. Modern 20–30 Gy involved-site fields carry far less risk than old mantle fields.
Review: section 08
In a British Columbia cohort, the risk of relapse within 5 years was 18% at diagnosis. What was the risk of later relapse for patients still relapse-free at 2 years?
Answer: B. Risks were 10%, 6% and 4% for patients relapse-free at 1, 2 and 3 years. Late relapses still occur, so biopsy any suspected late relapse.
Review: section 08
A 40-year-old woman had mantle-field radiotherapy at 18 and has never had breast screening. What should be arranged?
Answer: C. Women treated with chest RT between 10 and 30 years of age start screening at 25 (or 8 years after RT) and continue for life; the risk persists for decades.
Review: section 08
In a prospective Indian study of 396 children with Hodgkin lymphoma, about what proportion had received anti-TB treatment before the diagnosis?
Answer: B. 29% had received empirical anti-TB treatment, and they presented at a more advanced stage. In adults at Tata Memorial the figure was 16%.
Review: section 02
DNB, DM and USMLE Step 3 level: landmark trials, newer targeted drugs and difficult decisions.
Which statement about the S1826 trial is correct?
Answer: D. G-CSF was mandatory with BV-AVD and optional with N-AVD. 2-year OS was 99% vs 98%; the PFS gain (92% vs 83%) was the main result, with fewer treatment discontinuations (9% vs 22%).
Review: section 06
What was notable about ECHELON-1?
Answer: E. 6-year OS was 93.9% vs 89.4%. ECHELON-1 was the first trial in decades to show an overall survival gain in advanced cHL. ABVD was not PET-adapted, so all patients in that arm received 6 cycles of bleomycin.
Review: section 06
Which statement about HD21 is correct?
Answer: C. Grade 3–4 adverse events 42% vs 59%; PET2-negative patients needed only 4 cycles. HD21 enrolled adults 18–60, including stage IIB with a large mediastinal mass or extranodal lesions. 4-year OS was 98.6% vs 98.2%; febrile neutropenia occurred in 28% with BrECADD.
Review: section 06
In H10U (early unfavourable, PET2-negative), what did omitting radiotherapy show at 10 years?
Answer: D. OS 94.8% vs 94.3%; PFS 86.5% vs 91.4%. 20 of 22 relapses in the chemotherapy-only arm were at sites of earlier disease, the rationale for RT. Because relapses are salvageable, survival was unchanged.
Review: section 06
In HD16 (GHSG favourable, PET2-negative after 2 ABVD), what was the effect of omitting 20 Gy?
Answer: C. Omitting RT raised the relapse risk (HR 1.78) without changing survival. Late effects were not reported.
Review: section 06
What did CALGB 50801 show in bulky early-stage cHL?
Answer: A. Bulk is not by itself an indication for RT when the interim PET is negative; febrile neutropenia occurred in 8% without excess lung toxicity.
Review: section 06
In the E2496 trial, what happened to patients aged 60 or over treated with ABVD?
Answer: D. Bleomycin lung toxicity was fatal in 18% of those affected; grade ≥3 neutropenia occurred in 83%. This is why bleomycin is avoided over 60.
Review: section 06
In the S1826 subgroup aged 60 and over, how did N-AVD compare with BV-AVD?
Answer: B. Febrile neutropenia and infections were commoner in older patients. The benefit of N-AVD was largest in older adults; plan G-CSF and early review of fever.
Review: section 06
What did the phase 2 study of sequential BV → AVD → BV in patients aged 60 and over report?
Answer: E. Two BV lead-in doses, six AVD cycles, then four BV consolidation cycles; one-third had grade 2 neuropathy, mostly reversible.
Review: section 06
In a multicentre study of 936 transplanted patients, what was the 2-year PFS after autologous transplant according to the salvage regimen?
Answer: E. BV-based salvage gave 62%, platinum chemotherapy 50% and BV monotherapy 37%. Overall survival did not differ, and the comparisons are retrospective, but checkpoint-based salvage is now preferred.
Review: section 06
Which statement about the AETHERA trial is correct?
Answer: A. Neuropathy improved in about 90%. Overall survival was confounded by crossover. Sensory neuropathy occurred in 56% vs 16%; it resolved completely in 73% at 5 years.
Review: section 06
What did the GHSG/EBMT randomised trial of transplant in chemosensitive relapsed HL show?
Answer: C. 3-year freedom from treatment failure was 55% vs 34%. This trial and the British BNLI trial established autologous transplant as the standard for chemosensitive relapse.
Review: section 06
Which complications are more frequent when allogeneic transplant follows PD-1 blockade?
Answer: D. Post-transplant cyclophosphamide is considered for GVHD prophylaxis in this setting.
Review: section 06
A pre-transplant prognostic model gives 1 point for Karnofsky <90, 1 for chemoresistant disease, 2 for more than three prior regimens and 2 for extranodal disease. A patient has chemoresistant disease with extranodal spread, Karnofsky 90, two prior regimens. What is the risk group?
Answer: E. Chemoresistant 1 + extranodal 2 = 3, which falls in the intermediate group (1–3; 4-year PFS about 60%, vs 71% low and 42% high).
Review: section 06
A patient stopped nivolumab after a year in complete response and relapses 10 months later. What do retrospective data suggest about re-treatment with the same PD-1 inhibitor?
Answer: C. Re-treatment with nivolumab or pembrolizumab after discontinuation achieved responses similar to the initial course in reported series.
Review: section 06
Loss-of-function mutations in B2M, found in about 70% of cHL, have which effect?
Answer: D. It helps HRS cells escape cytotoxic T cells. Immune escape in cHL also involves CIITA alterations (MHC class II), 9p24.1 gain (PD-L1/PD-L2), regulatory T cells and immunosuppressive cytokines.
Review: section 04
A node biopsy shows large atypical cells that are strongly CD30-positive, CD15-negative, PAX5-negative and positive for CD4 and perforin. What is the most likely diagnosis?
Answer: C. ALCL: strong CD30, CD15 negative, PAX5 negative, T-cell antigens and cytotoxic markers, ALK positive or negative. cHL HRS cells are weakly PAX5-positive and usually CD15-positive.
Review: section 03
A young man has a large anterior mediastinal mass. The tumour cells express CD15 and strong CD30 but also strong CD20, CD79a and PAX5. What is the likely diagnosis and its significance?
Answer: C. Grey-zone lymphoma has features between cHL and primary mediastinal B-cell lymphoma and generally has a more aggressive course and inferior outcomes.
Review: section 03
This schematic H&E shows a large cell with a folded, lobulated nucleus inside a nodule of small lymphocytes. Immunostains: CD20+, CD45+, CD30−, CD15−. Which finding on the excised node best separates this from T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL)?
Answer: A. This is the LP ("popcorn") cell of NLPHL. NLPHL keeps a (partly) nodular, B-cell-rich pattern with FDC meshworks and CD57+ T-cell rosettes; THRLBCL is diffuse with CD8+ T cells and histiocytes and no FDC meshwork. Core needles may not show the pattern.
Review: section 03
A 50-year-old has NLPHL, stage IIIA, Hb 11 g/dL, with splenic involvement and no B symptoms. What is the LP-IPS and the usual approach if treatment is needed?
Answer: D. Age, stage and spleen score 3; treat with R-CHOP, R-CVbP or R-B. LP-IPS gives 1 point each for age ≥45, stage III–IV, Hb <10.5 g/dL and splenic involvement. LP-IPS ≥2 is higher risk; splenic involvement also raises the risk of transformation.
Review: section 06
Nine years after treatment for NLPHL, a patient develops B symptoms, splenomegaly and bone marrow involvement. What is the priority?
Answer: A. B symptoms and marrow involvement are unusual in NLPHL and suggest transformation, which is treated like an aggressive B-cell lymphoma. NLPHL does not transform into classic HL.
Review: section 06
In the GLOW analysis of completely excised stage IA NLPHL, how did radiotherapy compare with active surveillance?
Answer: E. Overall survival was 100% vs 97% (not significant). Surveillance is acceptable after complete excision for patients who wish to avoid RT, accepting more relapses.
Review: section 06
In paediatric low-risk cHL treated with two cycles of OEPA, what happens after a complete response?
Answer: B. GPOH-HD-2002 and EuroNet-PHL-C1 showed that radiotherapy can be omitted after an adequate response to OEPA, sparing children its late effects.
Review: section 06
What did AHOD1331 show in high-risk paediatric cHL?
Answer: D. RT was given for bulky mediastinal disease and slow responders in 53% and 57% of patients.
Review: section 06
Why is chemotherapy avoided in the 3 weeks before delivery in a pregnant woman with cHL?
Answer: A. Low maternal and newborn counts at delivery raise the risk of haemorrhage and infection. Timing birth near 39 weeks and pausing chemotherapy beforehand reduces cytopenia-related complications; G-CSF can be used if neutropenia and delivery coincide.
Review: section 06
What did van Nimwegen and colleagues find about heart failure after Hodgkin lymphoma treatment?
Answer: B. Median onset was more than 20 years after treatment; there was little evidence of an increase at mean heart doses of 1–25 Gy.
Review: section 08
Which statement about breast cancer after Hodgkin lymphoma is correct?
Answer: A. Neppelenbroek 2024 found a doxorubicin dose-related increase in breast cancer risk in adolescent and adult survivors, in addition to the effect of chest RT.
Review: section 08
In the GHSG HD7–HD12 analysis, what was the cumulative incidence of relapse at 10, 15 and 20 years?
Answer: E. Late relapses are uncommon but continue without a plateau; any suspected late relapse needs a biopsy because it may be NHL, another cancer or infection.
Review: section 08
In a Dutch cohort of women treated for HL between 15 and 40, what was the rate of premature ovarian failure with and without alkylating chemotherapy?
Answer: E. Risk rose by about 23% for each year of age at treatment. ABVD without pelvic RT preserves ovarian function in most women.
Review: section 08
In the large early-stage cohort cited in the survivorship review, when did deaths from causes other than HL overtake deaths from HL?
Answer: D. Second cancers and cardiovascular disease account for most late excess deaths, which is why follow-up shifts towards late effects after the first years.
Review: section 08
Prepared and reviewed by Dr. Haritha Chiramana for teaching. Facts compiled from current guidelines, primary trials and evidence summaries, written in our own words; drawings are original schematics, not patient images; no doses are included.