YMO Clinical Case for this week.
74 yr old lady was evaluated for a self detected neck node by ENT specialist. No history of any weight loss, fever, difficulty in talking , eating or swallowing or night sweats.
She has no addictions. She is diabetic and hypertensive for 15 yrs
Clinical examination revealed PS1 , multiple nodes on right side neck ( cervical level 3,4 And supraclavicular).No hepatosplenomegaly. No other lymphadenopathy.
FNA was done suggestive of Lymphoma. She was referred to me for further evaluation
1) What are the next evaluation needed for
a) Diagnosis with staging
b) Workup for Treatment
c) Differential diagnosis
CBC with Peripheral Smear
KFT, LFT
LDH (for IPI)
Uric Acid (TLS)
PET CT WB
Bone marrow (if cytopenias, non avid marrow on PET)
Excisonal Lymlh node biopsy for HPE ,
IHC for CD 5 , CD 10 , CD 20 , CD 23 , CD 43 , Cyclin D1
Molecular testing as per IHC report
Further 2 D Echo for (adriamycin eligibilty)
Expert comment:
In viva, roll out your answer as follows:
The first diagnosis would be a low grade NHL
Then a CLL
Please say:
After physical examination, I would like to do a peripheral smear.
Full marks awarded.
Which are the common criteria to decide favourable and unfavorable risks.
What will be the considerations in this elderly lady before starting treatment
B-symptoms
No of nodal sites
ESR
Bulky
She is elderly female with COPD
Will check cardiac function
Avoid bleomycin
Role of Brentuximab Vedotin in first line in HD?
Expert comment:
It is an expensive regimen generally used as salvage not frontline based on data availability
Frontline data is not much
High response rate and CR rate in salvage setting