Case 113 – update 1

Thank you for your contributions so far…

Initial work-up:

Our patient has expressed a short history of significant weight loss, fatigue and night sweats. In addition he has palpable superficial adenopathy. He has no clear infective history.

Examination reveals widespread lymphadenopathy.

His initial blood work shows a normal FBC, biochemistry profile, LDH and viral screen.

Specialist review:

Our patient is referred to Haematology for further assessment of suspected lymphoma.

A CT neck to pelvis confirms extensive, size significant lymphadenopathy above and below the diaphragm, with radiological changes suggestive of pulmonary involvement.

Pathology:

A needle core lymph node biopsy (groin) reveals abnormal nodal architecture with a predominant population of large cells with kidney-shaped nuclei and an eosinophilic region nears the irregular nuclei.

Questions:

1) Would you request any further staging investigations?

2) Based on the abnormal lymph node morphology findings, which immunohistochemical stains would you request?

3a) What is your preferred likely diagnosis?

3b) What is the most important prognostic marker in this case?

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