Until Proven Otherwise Flashcards
Firm Painless Lymphadenopathy in cervical or supraclavicular areas
Hodgkin Lymphoma
***Remember
a non-tender palpable firm mass/lump in neck in a young child? +/- h/o EBV infection or HIV? –> suspect lymphoma 1) Must do FBC first to exclude haematological malignancies( ALL is most common in children and palpable lymphadenopathy is one of the S/S) 2) If FBC reports abnormal (severe anaemia + leukocytosis & neutropenia + thrombocytopenia) then do peripheral blood film to see whether leukocytosis due to malignancy/inflammation if PBF reports numerous blast cells (>20%), then do Bone marrow biopsy to confirm followed by immunophenotyping by flow cytometry to sub-type it. If FBC was normal (doesn’t exclude ALL but makes it unlikely), then suspect it as Lymphoma (Hodgkin more common in young adults 20-30yrs) To exclude it, we do USG guided Excisional biopsy(preferred to preserve architecture) If Excisional bx not possible, then do Needle Core biopsy only in high risk patients. Findings -Reed-Sternberg Cells (multinucleated giant cells) Once confirmed, do CT scan of abd & thorax for staging purposes. Rx - induction,consolidation & maintenance
