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Welcome to clinical presentation

Presented by…

Dr. Nazia Sharmin

Resident, Phase B

Dept of haematology

BSMMU

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  • A 25 year old male presented with fever and G. lymphadenopathy

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  • fever
    • high grade
    • highest recorded temp was 102˙f
    • Not associated with chills and rigor
    • Subsided by taking antipyratics

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  • General examination….
  • Conscious
  • Co-operative
  • Anaemic
  • No jaundice, cyanosis
  • pulse : 95 b/min
  • BP :130/ 80 mm/hg
  • Temp: 102 ̊F
  • lymphadenopathy: cervical ,axillary, inguinal
  • Skin condition: normal, no bleeding manifestation or hyperpigmentation
  • Bony tenderness: absent

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Hb%

11.6g /dl

ESR

65 mm/1st hour

Platelet

500×10^9/l

WBC

21×10^9/l

Neutrophil

17.01×10^9/l

Lymphocyte

3.36×10^9/l

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PBF

  • RBC: anysocytocis with anisochromia.
  • WBC: Increased, mature with above count and distributions.
  • Platetet : Increased
  • Comments: Neutrophilic leukocytocis with Thrombocytocis

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  • CRP: 93.92mg/l
  • S. Ferritin: 24520ng/ml
  • LDH: 2307u/l

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Lymphnode biopsy and histopathology

  • Non-Hodgkin lymphoma, morphologically favours T- cell lymphoma.

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Immunohistochemistry:

  • Positive for CD2, CD3, CD4,CD5,CD7, CD8,

CD4/CD8 :1:4

  • Negative for: CD15, CD20,CD30,PAX5,

BCL-2,ALK-1,CD138,

Ki67: 30-35%

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  • compatible with PTCL (NOS).

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Bone marrow examination report:

  • Features suggestive of secondary reactive marrow. Possibility of lymphoreticular malignancy..

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  • 6 cycle of CHOEP

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2months after completion of Chemotherapy..

  • Present scenario-
  • Patient has irreguler fever, cervical lymphadenopathy and appearance of some skin lesions.

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  • LDH: 537 U/L
  • CRP: 25.65mg/l
  • S. ferritin:245ng/ml

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  • Re biopsy done from cervical lymph node .
  • Suggestive of PTCL .

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Peripheral T cell Lymphoma treated with chemotherapy:

  • PET-CT scan shows:
  • Multiple FDG avid cervical , bilateral axillary and inguinal lymphnode suggest hypermetabolic lymphnodes, needs histopathological evaluation.

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  • FDG avid bilateral cervical lymphnodes are seen at level I(SUVmax2.5), II(SUVmax3.2),III(SUVmax2.8),Iv(SUVmax2.8),vI(SUVmax1.8),bilateral axillary(SUVmax8.7),multiple mediastinal (SUVmax6.2),bilateral inguinal(SUVmax 3.6)
  • Deauville scoring:5
  • Multiple FDG avid cervical , bilateral axillary and inguinal lymphnode suggest hypermetabolic lymphnodes, needs histopathological evaluation.

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  • The PTCL ,NOS, is a heterogenous group of T-cell lymphomas .
  • They do not fit into any of the specific subtypes defined by the World Health Association classification system.

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  • The malignent cells are CD4+/CD8- with frequent loss of CD5 and CD7
  • They are usually medium to large in size with high proliferation rates.
  • The karyotype is typically complex with a wide variety of chromosomal abnormalities

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  • Median age at presentation is 57 years
  • Most of the patients have advanced stage of disease at diagnosis with frequent extranodal involvement of the skin , liver and bone marrow.

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Thank you