Haematology: Richter transformation: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Haematology: Richter transformation

Sample item

A 70-year-old man with long-standing chronic lymphocytic leukaemia develops fever, weight loss and a rapidly enlarging inguinal node with raised LDH. Excision of the node shows sheets of large cells with prominent nucleoli replacing the small lymphocytes. What has happened?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Transformation to diffuse large B-cell lymphoma

Richter transformation is the development of an aggressive large B-cell lymphoma in a patient with chronic lymphocytic leukaemia. Sudden node enlargement, systemic symptoms and a rising LDH should prompt a biopsy.

Option by option

  • A. Transformation to acute lymphoblastic leukaemia

    Transformation to a lymphoblastic leukaemia is not the recognised aggressive evolution of CLL.

  • B. Transformation to hairy cell leukaemia

    Hairy cell leukaemia is a separate disease and is not a transformation of CLL.

  • C. Transformation to diffuse large B-cell lymphoma (correct)

    Correct. Large-cell transformation of CLL to diffuse large B-cell lymphoma is the classic Richter transformation.

  • D. Progression to follicular lymphoma, grade 1

    Follicular lymphoma grade 1 is a low-grade neoplasm and would not explain sheets of large cells with rapid growth.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is C, Transformation to diffuse large B-cell lymphoma. Richter transformation is the development of an aggressive large B-cell lymphoma in a patient with chronic lymphocytic leukaemia.

Why is "Transformation to acute lymphoblastic leukaemia" not the answer?

Transformation to a lymphoblastic leukaemia is not the recognised aggressive evolution of CLL.

Why is "Transformation to hairy cell leukaemia" not the answer?

Hairy cell leukaemia is a separate disease and is not a transformation of CLL.

Why is "Progression to follicular lymphoma, grade 1" not the answer?

Follicular lymphoma grade 1 is a low-grade neoplasm and would not explain sheets of large cells with rapid growth.

What concept does this question test?

It tests Haematology: Richter transformation in Pathology. Sudden node enlargement, systemic symptoms and a rising LDH should prompt a biopsy.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Haematology: Richter transformation?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.