A 62 year old male with swelling in neck

Swelling in neck diffrential diagnosis
1. Cingenital
  1. Thyroglossal cysts
2. Developmental
  1. Branchial cysts
3. Skin and subcutaneous tissue
  1. Lipooma
4. Thyroid swellings
  1. solitary thyroid nodule
5. Salivary glands tumors
  1. Pleomorphic adenoma
6. Tumors of parapharyngeal space
  1. deep lobe parotid
7. Reactive neck lymphadenopathy
  1. Tonsilitis
8. Malignant neck node
  1. metastases
  2. Lymphoma
    1. Neoplastic proliferation oflymphoid cells that forms a mass; may arise in a lymph node or in extra nodal tissue
      1. Lymphnode
        Lymph Node Development
        The lymph sacs are transformed into groups of lymph nodes in early fetal life, at about the third month, except the upper portion of the cisterna chyli, which persists.
        The mesenchymal cells will give rise to the lymph node capsule and the connective tissue framework of the node.
        Lymph Node distribution
        Lymph Nodes of the Neck
        major site of B and T lymphocytes
        Histology of the Thymus
        Site of T-cell differentiation and maturation
        Located in the anterosuperior mediastinum
        Encapsulated
        Cortex dense with immature cells
        Medulla pale with Mature Tcells and Hassal corpuscles (Reticular cells)
        Lymphocytes Functions
        Lymphadenopathy
        Acute infections
        Chronic infections (Cat Scratch Disease).
        Primary or secondary tumors
        Autoimmune Diseases.
    2. Risk Factors
      1. Epstein-Barr virus infection/mononucleosis
      2. Age & Gender
      3. Family history
      4. Weakened immune system
      5. Exposure to certain chemicals and drugs
      6. Infections that directly transform lymphocytes
        HTLV-1
        EBV
        HHV-8
    3. Hodgkin vs. Non-Hodgkin Lymphoma
      1. Classification
        Hodgkins Lymphoma
        Classic Hodgkins Lymphoma
        Nodular Sclerosis type\ Mixed cellularity\ Lymphocyte Rich\ Lymphocyte Depleted
        Nodular Lymphocyte predominant Hodgkins lymphoma
        Non-Hodgkin Lymphoma
        Relation Between Non-Hodgkin Lymphoma and Leukemia
        Chronic lymphocytic leukemia
        Similar to small-cell lymphocytic lymphoma
        Transform into diffuse large B cell lymphoma by Richter transformation
        Richter transformation is common in chronic lymphocytic leukemia with deletion 17p, or trisomy21 or NOTCH1 mutations.
        Adult T cell leukemia\lymphoma
        It is T cell non-Hodgkin lymphoma that is caused by HTLV1
        there is lymphocytosis in blood.
        Aggressive non-Hodgkin lymphomas
        Account for 60 % of all non-Hodgkin lymphomas
        Younger patents
        More B symptoms
        Short natural history
        Median survival rate (1-2 years).
        Indolent non-Hodgkin lymphomas
        Account for 40 % of all non-Hodgkin lymphomas.
        Older patients.
        Few B symptoms.
        Long natural history.
        Median survival rate (7 to 10 years).
    4. Diagnosis
      1. Excisional biopsy
      2. Immunohistochemistry
      3. Flow cytometry
        CD 19, CD20 for B cell lymphomas
        CD 3, CD 4, CD8 for T cell lymphomas
      4. Chromosome changes
        4;18 translocation in follicular lymphoma (bcl-2 oncogene)
        t(8;14), t(2;8), t(8;22) in Burkitt lymphoma (c-myc oncogene)
        t(11;14) in mantle cell lymphoma (cyclin D1 gene)
    5. Staging
      1. Blood tests
      2. Bilateral bone biopsy & aspirate
      3. Lactic dehydrogenase, beta-2 microglobulin levels
      4. Chest x-ray, CT scan
      5. PET
      6. Lumbar puncture in case of : AIDS NHL
    6. Management
      1. First-line treatment for stages I & II
      2. First-line treatment for stages III & IV
      3. Follow-up care

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A 62 year old male with swelling in neck

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	Created by hamda ali about 5 years ago