Lymphoma presenting as neck node. History and clinical examination proforma.

1. LYMPHOMA CASE
PRESENTATION
DR. AASTHA SHAH
RADIATION ONCOLOGIST

2. Presenting Complaints
I am presenting a case of 18 year old unmarried Hindu female student residing at Ujjain,
Madhya Pradesh presenting with chief complaints of
•Swelling over Left side of neck since 6 months
• On and off fever since 4 months
She was apparently alright before 6 months when she noticed a small pea sized swelling in
left side of her neck swelling which gradually increased in size to present size of a large
lemon.Swelling is painless in nature and not associated with redness,ulceration or
discharge.She had episodes of on and off fever since 4 months which was associated with
chills and evening rise in temperature for which she consulted physician at her place.He
prescribed her some medications but details unavailable.Fever subsided after medications
temporarily but then again she had similar episodes of fever. She gives h/o weight
loss(could not quantify).

3. Negative history
No history of
● Pain in ear or ear discharge
● Nasal discharge
● Oral ulcer/toothache/tooth extraction/scalp infection
● Difficulty in swallowing
● Change of voice/cough/breathlessness/chest pain/hemoptysis
● Trauma to upper limb/swelling in armpit/boil
● Abdominal pain/bleeding gums
● Excessive sweating/itching/Excessive feeling of fatigue
● Burning micturition/haematuria/pervaginal bleeding
● Chronic medication in past

4. Personal history
● Diet: Vegetarian
● Appetite:Adequate
● Sleep:Adequate
● Bowel/Bladder:Unaltered
● Addiction:Nil
● Drug allergy:Nil

5. Past history
● No h/o similar illness in past.
● No h/o Tuberculosis in past or contact Tuberculosis.
● No h/o previous blood transfusions or any surgical procedure.
● No h/o Diabetes or heart ailment or asthma in past.
● No h/o any prior radiation.

6. Family history
● Both the parents are alive and she has a younger sibling(brother).
● There is no history of major illness in family (any cancer/heart ailment)

7. Menstrual history
● Age of menarche: 13 years.
● Menstrual cycles occur at regular periodic intervals with moderate pain with moderate
bleeding(2 pads/day for 4-5 days).

8. General Examination
Patient has been explained about examination procedure in detail and verbal consent
taken.Patient examined in adequate light and proper exposure with adequate privacy.
Patient is conscious/cooperative and well oriented to time/place/person.She is average built
and nourished.No pallor/icterus/cyanosis/clubbing edema.
Height:42 kg Weight:156 centimetre
● Pulse :88 bpm in right radial artery in sitting position; regular and good force,volume
and tension in sitting position.
● BP:120/80 mm Hg in right brachial artery in supine position.Noradioradal
radiofemoral delay
● RR:18 cycles/min;regular and thoracoabdominal

9. Local examination
A.Inspection
Right side of neck:No abnormality seen.
Left side:An approximately 4*3 cm spherical swelling appears in left anterior upper
neck.Skin over swelling appears normal.No evidence of redness/ulceration/discharge or
dilated veins over swelling.It doesn’t move with swallowing or protrusion of tongue.No
restriction of neck movement.
B Palpation
Inspectory findings are confirmed by palpation.Temperature over swelling is normal
single 4*4*3 cm lymph node palpable on left side of neck from Level II to Level III which
is firm, rubbery,discrete,non tender and mobile.Skin over swelling free.No fixity to muscle

10. No any other lymph nodes palpable on left side of neck including level IV/level
V/preauricular/postauricular/occipital.Similarly no lymph nodes palpable on the right side
of neck.No b/l axillary/epitrochlear/paraaortic/inguinal/popliteal lymph nodes palpable.
No visible and palpable abnormality detected in oral cavity, oropharynx and nasal cavity .

11. Systemic examination
P/A: Inspection- Abdomen is flat.Umbilicus is central and inverted.No dilated veins or any
scar seen.
Palpation-No tenderness/guarding/rigidity present.No organomegaly present.No free fluid.
Auscultation-Bowel sounds present.
RS: Air entry bilaterally equal.No added sounds
CNS:Higher mental functions normal.
CVS:S1S2 normal.No abnormal sounds heard.