A 62 year old male with swelling in neck

A 62 year old male with swelling in neck

1. Swelling in neck diffrential diagnosis

   • Cingenital
     • Thyroglossal cysts
   • Developmental
     • Branchial cysts
   • Skin and subcutaneous tissue
     • Lipooma
   • Thyroid swellings
     • solitary thyroid nodule
   • Salivary glands tumors
     • Pleomorphic adenoma
   • Tumors of parapharyngeal space
     • deep lobe parotid
   • Reactive neck lymphadenopathy
     • Tonsilitis
   • Malignant neck node
     • metastases
     • Lymphoma
       • Neoplastic proliferation oflymphoid cells that forms a mass; may arise in a lymph node or in extra nodal tissue
         • 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.
       • Risk Factors
         • Epstein-Barr virus infection/mononucleosis
         • Age & Gender
         • Family history
         • Weakened immune system
         • Exposure to certain chemicals and drugs
         • Infections that directly transform lymphocytes
           • HTLV-1
           • EBV
           • HHV-8
       • Hodgkin vs. Non-Hodgkin Lymphoma
         • 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).
       • Diagnosis
         • Excisional biopsy
         • Immunohistochemistry
         • Flow cytometry
           • CD 19, CD20 for B cell lymphomas
           • CD 3, CD 4, CD8 for T cell lymphomas
         • 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)
       • Staging
         • Blood tests
         • Bilateral bone biopsy & aspirate
         • Lactic dehydrogenase, beta-2 microglobulin levels
         • Chest x-ray, CT scan
         • PET
         • Lumbar puncture in case of : AIDS NHL
       • Management
         • First-line treatment for stages I & II
         • First-line treatment for stages III & IV
         • Follow-up care

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