Treatment of Follicular Lymphoma: Case 1

January 2014

• 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.