Head and neck tumours: unicentric Castleman disease: practice question

A ENT 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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ENT · Head and neck tumours: unicentric Castleman disease

Sample item

A 28-year-old has a painless 4 cm solitary cervical node for two years, with no fever and a normal ESR. Excision shows regressed germinal centres with onion-skin mantles and hyalinised vessels. What is the treatment?

ARadiotherapy to the neckBSurgical excision, which is curative for localised diseaseCCHOP combination chemotherapyDAntitubercular therapy

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

The answer and the reasoning

B. Surgical excision, which is curative for localised disease

The hyaline-vascular type of Castleman disease commonly presents as a solitary, asymptomatic lymph node mass, and complete excision of unicentric disease is curative. Multicentric disease needs systemic therapy such as siltuximab or rituximab.

Option by option

A. Radiotherapy to the neck
Radiotherapy is not first-line because surgical removal is curative.
B. Surgical excision, which is curative for localised disease (correct)
Correct. Complete excision cures unicentric hyaline-vascular Castleman disease.
C. CHOP combination chemotherapy
CHOP chemotherapy is for aggressive lymphoma, which is not shown on histology.
D. Antitubercular therapy
Antitubercular therapy is for caseating granulomas, which are absent here.

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.

Questions about this ENT question

What is the answer to this ENT question?

The best answer is B, Surgical excision, which is curative for localised disease. The hyaline-vascular type of Castleman disease commonly presents as a solitary, asymptomatic lymph node mass, and complete excision of unicentric disease is curative.

Why is "Radiotherapy to the neck" not the answer?

Radiotherapy is not first-line because surgical removal is curative.

Why is "CHOP combination chemotherapy" not the answer?

CHOP chemotherapy is for aggressive lymphoma, which is not shown on histology.

Why is "Antitubercular therapy" not the answer?

Antitubercular therapy is for caseating granulomas, which are absent here.

What concept does this question test?

It tests Head and neck tumours: unicentric Castleman disease in ENT. Multicentric disease needs systemic therapy such as siltuximab or rituximab.

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 Head and neck tumours: unicentric Castleman disease?

Learn tuning fork results and audiogram patterns by sketching them. Then use the flashcards and the other ENT 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.