A 68-year-old male auto mechanic presents to his primary care physician with a chief complaint of bilateral, painless ma
Posted: Wed Apr 27, 2022 7:22 am
A 68-year-old male auto mechanic presents to his primary care
physician with a chief complaint of bilateral, painless masses in
the neck region of at least 6
months' duration. He has a 120 pack-year smoking history, and his
family history includes a father and brother with thyroid cancer.
His past medical history is
positive for rheumatoid arthritis. On physical examination, the
patient is found to have bilateral supraclavicular and cervical
lymphadenopathy consisting of
matted groups of lymph nodes that were painless to palpation. The
patient was afebrile and had experienced an unintentional decrease
in weight from 195
pounds to 180 pounds over a 6-month interval.
All parameters of the initial complete blood count (CBC) were
normal, and the peripheral smear was without morphological
abnormality. A chest x-ray film
demonstrated hilar adenopathy without any recognizable parenchymal
lung lesions. Excisional biopsy of a group of nodes was performed.
On microscopic
examination there was diffuse effacement of lymph node architecture
by a population of relatively uniform cells, averaging 20 to 40 μm
in diameter, with round
to slightly irregular nuclei and occasional prominent nucleoli.
Immunophenotypically, the cells were characterized by the
expression of CD45, CD19, CD20, and κ
light chains. No T-cell antigens were detected on the abnormal
cells.
1. What pathological processes must be considered in the
evaluation of lymphadenopathy?
2. What is the most likely diagnosis based on the available
data?
3. What additional studies should be performed before
therapy is instituted?
physician with a chief complaint of bilateral, painless masses in
the neck region of at least 6
months' duration. He has a 120 pack-year smoking history, and his
family history includes a father and brother with thyroid cancer.
His past medical history is
positive for rheumatoid arthritis. On physical examination, the
patient is found to have bilateral supraclavicular and cervical
lymphadenopathy consisting of
matted groups of lymph nodes that were painless to palpation. The
patient was afebrile and had experienced an unintentional decrease
in weight from 195
pounds to 180 pounds over a 6-month interval.
All parameters of the initial complete blood count (CBC) were
normal, and the peripheral smear was without morphological
abnormality. A chest x-ray film
demonstrated hilar adenopathy without any recognizable parenchymal
lung lesions. Excisional biopsy of a group of nodes was performed.
On microscopic
examination there was diffuse effacement of lymph node architecture
by a population of relatively uniform cells, averaging 20 to 40 μm
in diameter, with round
to slightly irregular nuclei and occasional prominent nucleoli.
Immunophenotypically, the cells were characterized by the
expression of CD45, CD19, CD20, and κ
light chains. No T-cell antigens were detected on the abnormal
cells.
1. What pathological processes must be considered in the
evaluation of lymphadenopathy?
2. What is the most likely diagnosis based on the available
data?
3. What additional studies should be performed before
therapy is instituted?