case presentation diagnosed as lymphoma

1. CASEPRESENTATION
BY
DR/ MOHAMEDABDEL RAZEK
PEDIATRICEGYPTIANFELLOWSHIP
SHAQRAGENERALHOSPITAL

3. CASEPRESENTATION
•3.5 years, female , Saudi , came
to pedia OPD with
submandibular swelling since
one week, no pain no fever no
rash, no jaundice, but some

4. EXAMINATION
•FAIR GENERAL CONDITION
• STABLE ,ALERT, CONCIOUS,ACTIVE
,ORIENTED.
•CHEST:NAD
• HT: S1+S2+0
•ABD:LAX , SOFT,NO HSM

5. LOCALEXAMINATION
•Soft submandibular swelling measuring about
2 cm X1.5 cm not tender not hot no rash above it,
movable not attached to underlying tissues .
•My think : may be enlarged LN or submandibular
salivary gland with duct obstruction for
investigations.
•No other palpable LNS all over the body.

6. INVESTIGATIONS
 CBC :
WBS 18400 :Neutrophil 750 ,Lymphocytes 17000
HB 7.96 ,
PLT 35200 ,
 BLOOD FILM : marked thrombocytopenia , absolute lymphocytosis with
16 % atypical lymphocyte ,4% atypical mononuclear cells, moderate
normocytic normochromic anemia with anisocytosis , with
recommendation for imaging for organomegaly , immunophenotyping ,
bone marrow aspirate or BM biopsy
CRP : -VE ,
ESR : 47 MM/ H
 RETICS : 1.54%,
CHEMISTRY : no abnormalities.

7. INVESTIGATIONS
ABDOMINALULTRASOND: Mild splenomegaly with no focal
lesion, no other abnormalities.
NECKULTRASOUNDSTUDY: Bilateral enlargement of
submandibular LNS with the largest at RT side measuring
2.3x1.3 cm hypoechoic with loss of echogenic hilum with
increase vascularity and bilateral upper and lower deep
cervical and intra parotid LNS enlargement
FOR further FNAC to exclude LYMPHOMA

8. MY ACTION
Fax sent to higher centers for
further investigations to
diagnose and treatment…..
Accepted at KING FISAL
specialist hospital

9. LYMPHOMA
WHATISLYMPHOMA?
Lymphocytes are white blood cells in the immune system.
They fight off infections so we can stay healthy. If these
cells grow and multiply uncontrollably, they can form a
type of cancer called lymphoma.
LYMPHOMA is more common in adults, but it is actually the
third most common form of cancer in children, after
leukemia and brain tumors.

10. TYPES OF LYMPHOMA
THEREARE TWOMAINTYPES OF LYMPHOMA:
I. HODGKIN LYMPHOMA (also called Hodgkin's
disease) and
II.NON-HODGKIN LYMPHOMA.
Each type has several subtypes. These differ
according to how lymph node tissue appears under
a microscope, the cells affected, and other factors.

11. HODGKINLYMPHOMA
Hodgkin lymphoma: most commonly affects children age
15 and older. It results in abnormal cells called
Reed-Sternberg cells in the cancerous lymph
node.
Doctors don’t yet know what causes Hodgkin
lymphoma.
There is a connection between the Epstein-Barr
virus, which causes mononucleosis, and Hodgkin
lymphoma in many young patients

12. NON-HODGKINLYMPHOMA
•Non-Hodgkin lymphoma in children behaves
differently than in adults. It tends to
be aggressive and fast-growing, and
requires intensive therapy.

13. SYMPTOMSOF LYMPHOMAIN CHILDREN
Lymphoma most often causes one or more swollen lymph
nodes, usually in the neck, underarm, or groin. These are
painless. Lymphoma can also cause these symptoms:
1.Unexplained fever
2.Night sweats
3.Loss of appetite or weight loss
4.Coughing or difficulty breathing
5.Swelling in the abdomen ( lymphomas in the chest or
abdomen can grow very large before they cause
symptoms)

14. INVESTIGATIONS
IMAGING
Including chest x-rays; CT scan , Ultrasound
MRI, bone scan, and PET (positron emission
tomography)
 BLOODTESTS
Including a complete blood count ,blood
film,(CBC) and blood chemistries and others.
 LYMPHNODEBIOPSY

15. INVESTIGATIONS
BONEMARROWASPIRATIONANDBIOPSY
 LUMBARPUNCTURE(LP)
Lymphoma may invade the central nervous system
ASSESSMENTOF ORGANFUNCTION
To allow safe delivery of treatment the function of the
lungs, the heart and the kidneys is assessed. Occasionally
hearing is tested as well.

16. TREATMENT
LYMPHOMATREATMENTSINCLUDE:
ACTIVE SURVEILLANCE : Some forms of lymphoma are
very slow growing. Doctor may decide to wait to treat
lymphoma when it causes signs and symptoms that
interfere with daily activities. Until then, periodic tests
to monitor the condition.
CHEMOTHERAPY : Chemotherapy uses drugs to destroy
fast-growing cells, such as cancer cells
RADIATION THERAPY : Radiation therapy uses high-
powered beams of energy, such as x-rays and protons, to
kill cancer cells.

17. TREATMENT
BONE MARROW TRANSPLANT : A bone marrow transplant, also
known as a stem cell transplant, involves using high doses of
chemotherapy and radiation to suppress bone marrow. Then
healthy bone marrow stem cells from same body or from a donor
are infused into blood where they travel to bones and rebuild
bone marrow again.
OTHER TREATMENTS : Other drugs used to treat lymphoma
include targeted drugs that focus on specific abnormalities in
cancer cells. Immunotherapy drugs use immune system to kill
cancer cells. A specialized treatment called chimeric antigen
receptor (CAR)-T cell therapy takes body's germ-fighting T cells,

18. PROGNOSIS
•Thanks to advances in the
understanding and treatment of these
diseases, approximately 90 percent of
children with Hodgkin lymphoma and
non-Hodgkin lymphoma now remain
cancer free after treatment.

19. .
THANK YOU