A 71-year-old female reports having symptoms of bilateral axillary swelling of 1.5 years’ duration and presents with diffuse inguinal and cervical adenopathy.
Past medical History: 15-year history of treatment for rheumatoid arthritis with methotrexate
Physical examination:
The patient is generally well-appearing; temperature, pulse, blood pressure, and HEENT are all WNL; extremities show no edema.
Cardiac exam is normal; chest is clear
Abdomen shows no abnormal hepatosplenomegaly
Lymph nodes: left axillary 1.5 cm, right axillary 2 cm; cervical and inguinal nodes <1 cm bilaterally; non-tender
Notable laboratory findings:
CBC with diff, WNL
LDH, 148
Right groin excisional node biopsy shows small lymphocytes with nuclear indentations (centrocytes) and large lymphocytes without indentations (centroblasts).
Pathology: t(14;18); co-expression of Bcl2, CD10, CD20.
CT shows scattered adenopathy in the cervical, axillary, mesenteric, and pelvic regions. The largest lymph node measures 4.5 cm. The remaining lymph nodes are smaller than 3 cm.
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