April 19, 2017

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.