A 26-year-old man has noted lumps in his neck that have been enlarging for the past 6 months. On physical examination, he has a group of enlarged, nontender right cervical lymph nodes. A biopsy of one of the lymph nodes microscopically shows macrophages, lymphocytes, neutrophils, eosinophils, and a few plasma cells. There are scattered CD15+ large cells with multiple nuclei or a single nucleus with multiple nuclear lobes, each with a large inclusion-like nucleolus. What is the most likely cell of origin with infectious agent for these large cells?
The large cells are Reed-Sternberg cells, and they elaborate cytokines that promote an accompanying reactive cellular proliferation that forms the bulk of the neoplastic mass. Reed Sternberg cells are of B-cell origin, and in many cases, Epstein-Barr virus (EBV) infection can be demonstrated in these cells. The other listed options are not part of the pathogenesis for Hodgkin lymphoma.
B lymphocyte, Epstein-Barr virus
CD4+ cell, human T lymphotropic virus
Endothelial cell, Kaposi sarcoma herpesvirus
Macrophage, human immunodeficiency virus
Blood