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Case study: lymphoma/ granulomatous disease

Case study: lymphoma/ granulomatous disease. WJ CONRADIE Department of imaging sciences University of the free State September 2012. History. 12 April 2012 36 year old female (black) Referred to Surgery department from private GP RVD + on ART since 13/01/2012 (EFV, TDF, Lamivudine)

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Case study: lymphoma/ granulomatous disease

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  1. Case study: lymphoma/ granulomatous disease WJ CONRADIE Department of imaging sciences University of the free State September 2012

  2. History • 12 April 2012 • 36 year old female (black) • Referred to Surgery department from private GP • RVD + on ART since 13/01/2012 (EFV, TDF, Lamivudine) • PTB on treatment since 19/03/2012 • Presents with: • Right neck mass • Started as small lump 2 months ago • Progressing in size • Painful

  3. Clinical exam • Large solid mass • Extending from right earlobe to angle of jaw • Not mobile • No bruit • No fluctuance • Smaller lympnodes right cervical area • PROBLEM LIST: • Enlarging mass in upper cervical region (?lymphoma) • Plan:Ultrasound then TRUCUT

  4. Incisional biopsy • 19 April 2012 • Wedge incision made into mass in posterior triangle of neck • Skin closed with sub-cuticularmonocryl sutures • No complications • Discharged following day • Plan: • F/U in 2 weeks for results • 29 May 2012 • CT scan

  5. Spaces involved

  6. Differential diagnosissolid tumor

  7. Histology Results DIAGNOSIS: LARGE B-CELL LYMPHOMA • 23 May 2012 • Microscopy • Fibro-fatty tissue; muscle and tumor • Atypical cells • large hyperchromatic nuclei • Scanty eosinophilic cytoplasm • Prominent nuclear polymorphism • Tumor infiltrate skeletal muscle • Immuno-histochemical stains • CK/AE13 and MNF116 - Negative (Carcinomas) • CD3 - Negative (T cell origin) • CD20/10 - Positive (B cell origin) • Ki67 - Positive (80%) (Mitotic activity)

  8. outcome • 31 May 2012 • (Parotid tumor?) • No infiltration of bone • Cervical and axillary lympnodes • PLAN: • Theatre on 07/08/2012 • superficial parotidectomy • cervical dissection • Missed theatre date! • September 2012 • Mass still enlarging • Tender • Not mobile • PLAN: • Repeat CT • Surgery on 16/10/2012

  9. references • Harnsberger. Diagnostic Imaging: Head and neck.First edition; 2006. AMIRSYS. Elsevier Saunders. • Weissleder. Primer of Diagnostic Imaging. Fifth edition; 2011. Elsevier Mosby. • Robbins and Cotran. Pathological Basis o Disease. Eight Edition. Saunders Elsevier

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