Hematology Question 28 Instructor

A 25 year old male is referred for the evaluation of head and neck lymphadenopathy in the context of weight loss and malaise.

Consider the following points for discussion:

  1. What are B symptoms?
  2. What type of specimen would be required to confirm a diagnosis of lymphoma?
  3. Discuss the differential diagnosis of lymphadenopathy.

The B symptoms are:

  • Unexplained loss of more than 10% of body weight in the 6 months before diagnosis.
  • Unexplained fever >38 degrees C.
  • Drenching night sweats.

The single most useful diagnostic test is a representative, technically adequate, and properly evaluated biopsy, with either an excisional or Core biopsy. An FNA is not acceptable for a diagnosis of lymphoma.

A differential diagnosis for lymphadenopathy is shown below:

Reactive Inflammatory Neoplastic
Bacterial (any infection, TB, Lyme, brucellosis, cat-scratch disease) Collagen vascular disease (RA, dermatomyositis, SLE, vasculitis, Sjögren) Lymphoproliferative disorder/Lymphoma
Viral (EBV, CMV, HIV) Drug hypersensitivity Metastatic cancer
Parasitic (toxoplasmosis) Sarcoidosis, amyloidosis, Kikuchi’s disease Langerhans Histiocytosis
Fungal (histoplasmosis) Serum sickness

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