Question

10/m presents with CERVICAL L. node+, Surface Ig +, CD34−, 5−, 23−, tdt −, cd 10+, 19+:

• A. Burkitts Lymphoma
• B. DLBCL
• C. Anaplastic
• D. B-ALL

Hint:

TdT−, CD34− and surface Ig+ mean a MATURE B-cell — that rules out the precursor leukaemia; then CD10+ germinal-centre + child + starry-sky points to one high-grade lymphoma.

Answer 1

The Correct Option is A

Step 1: Decode the immunophenotype. A 10-year-old male with cervical lymphadenopathy. The flow markers are: surface Ig positive, CD10 positive, CD19 positive, and TdT negative, CD34 negative. Surface immunoglobulin and the absence of TdT/CD34 indicate a mature (peripheral) B-cell, not an immature precursor.

Step 2: Use the markers to localise the diagnosis. CD19 confirms B lineage; CD10 indicates a germinal-centre B-cell. A mature, CD10-positive, surface-Ig-positive B-cell tumour in a child presenting with nodal/extranodal mass is classically Burkitt lymphoma. The smear shows the typical "starry-sky" high-grade lymphoid cells with vacuolated cytoplasm.

Step 3: Select the answer. Mature B phenotype (sIg+, TdT-, CD34-) + CD10+/CD19+ + child + rapidly growing mass = Burkitt lymphoma - Option A.

Step 4: Why the others are wrong. (D) B-ALL is the key distractor: it is a precursor B-cell tumour and is TdT POSITIVE, CD34 POSITIVE and surface-Ig NEGATIVE - exactly the opposite of this case, so it is excluded. (B) DLBCL also is mature B, but it is predominantly an adult disease and is not the classic CD10+ "starry-sky" childhood high-grade lymphoma described here. (C) Anaplastic large cell lymphoma is a T-cell/null lymphoma expressing CD30/ALK and would not be CD19+/CD10+/sIg+.

Final Answer: Option A - Burkitt lymphoma.