Lymphosarcoma
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Transcript of Lymphosarcoma
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Lymphosarcoma
Elmo Yandle• 4 year old male intact American Staffordshire terrier
• Was presented to the NCSU Internal Medicine service for evaluation of 2 week history of generalized lymphadenomegaly, lethargy and inappetance. Elmo has a history of sneezing, pruritis, and red eyes.
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Elmo Yandle• Physical Exam:
– BAR, TPR - Normal – EENT: Mild epiphora OU and episcleral injection OU. – Integument: 3-4 cm abrasion on right side of prepuce– MSN: ambulatory on all four limbs, good muscle tone,
neurologically alert and appropriate – GIGU: Liver and spleen enlarged on palpation. – PLN: Generalized lymphadenomegaly. Bilaterally
enlarged zygomatic, submandibular, prescapular, axillary, inguinal, and popliteal lymph nodes.
– H/L: Heart and lungs auscult normally
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Elmo Yandle
• Diagnostic tests– 1. CBC - Mildly
thrombocytopenia, lymphoblast cells noted in blood smear (mild blastemia).
– 2. Chemistry panel - Mildly elevated amylase at 1122 (RR: 347-1104)
– 3. Urinalysis - Concentrated urine (1.048)
– 4. Lymph node aspirates - Consistent with lymphoma
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Elmo Yandle
Diagnosis: Lymphosarcoma
Next Step: Staging for prognosis• - Stages I-V• - Substages A and B• - Phenotyping• - Hypercalcemic
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Elmo Yandle
• Results of Further Diagnostics:– Thoracic Radiographs
• Possible pulmonary nodule located in left 6th intercostal space
– Abdominal Ultrasound • Splenomegaly, diffuse hypoechoic foci in spleen• Hepatomegaly• Enlarged Bilateral MILN, and enlarged hepatic LN• FNA of spleen and liver = consistent with LSA
– Bone Marrow Aspirate• Consistent with LSA
– Flow Cytometry – insufficient sample
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SPLEEN
Splenomegaly with punctate hypoechoic foci within the spleen
Lymphoma of the spleen can vary in appearance from diffusely hyper to hypoechoic. This is a more classical appearance “Swiss cheese”
FNA is required to corrobarate sonographic findings
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LIVER
• Hepatomegaly and normal echogenicity when compared to the spleen– The echogencity of the liver can vary
with lymphoma. Hepatomegaly is often reported. Splenic abnormalities are more common with lymphoma.
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Abdominal Lymph Nodes
Enlarged Right MILN Enlarged Hepatic Lymph node
Enlarged Splenic Lymph node
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Elmo Yandle
• Diagnosis:– Stage V, substage B Multicentric
Lymphosarcoma
• Treatment:– Chemotherapy:– L-asparaginase and prednisone
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Elmo Yandle
• Follow Up:– Transferred to NCSU
Oncology service for chemotherapy
– Complete Remission as of 11/27/06.