A 62-YEAR-OLD MALE WITH SWELLING IN NECK

A 62-YEAR-OLD MALE WITH SWELLING IN NECK

1. Rt.sided neck swelling

   • noted it after sore throat & was prescribed antibiotics
     • felt small swelling in Lt. inguinal region, dropped around 7-8kg
       • cervical lymph node biopsy were ordered.
         • sections show diffuse effacement of lymph node architecture by large lymphoid cells
           • diagnosis: Non-Hodgkin lymphoma
             • confirmed the final diagnosis of Diffuse Large B cell NHL
               • immunohistochemistry: +ve for CD19, CD20, and CD45 and -ve for CD5, CD3. Variable expression of CD10 and BCL6 was noted.
                 • CT: Rt. cervical & Lt. inguinal with diffuse involvement of retroperitoneal nodes, high LDH
                   • stage IIIB Diffuse large B cell Non-Hodgkin lymphoma.
                     • treated with six cycles of rituximab + CHOP chemotherapy
                       • R-CHOP
                       • R-CVP
                       • FCR
                       • DA-EPOCH
                     • low
                       • small lymphocytes, flollicular
                     • intermediate
                       • diffuse small, diffuse large, diffue mixed
                     • high
                       • large cell, immunoblastic, lymphoblastic
                     • miscellaneous
                   • diagnosis
                     • biopsy
                     • Contrast CT
                     • X-ray
                     • PET
                     • CBC
                     • immunohistochemstry
                     • flow cytometry
                 • B cell lymphoma
                   • CD19, CD20
                 • T cell lymphoma
                   • CD3, CD4, CD8
             • hodgkin
               • reed stirnberg cells
               • Ass. EBV
               • localized, single
             • non hodgkin
               • multiple, spread
               • majority B cells
               • Ass. HIV
         • Core needle biopsy
         • Fine needle aspiration
         • Excisional biopsy
           • permits the hematopathologist to evaluate the architecture of the lymph node.
       • signs & symptoms
         • swollen lymph nodes
         • Abdominal pain
         • Night sweats
         • weight loss
     • risk factors
       • low immunity
       • infections
         • HIV
         • EBV
         • H.pyori
         • HCV
         • HTLV-1
       • age above 60
   • lymph node distribution

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