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Abstract: The patient presented with unexplained generalized lymph node enlargement, with the enlarged lymph nodes distributed in the neck, supraclavicular region, axilla, and groin, without precipitating factors such as colds and other site infections, and without concomitant symptoms such as fever, night sweats, and weight loss. The final pathological and immunohistochemical results confirmed the diagnosis of mesenchymal large-cell lymphoma. The treatment was systemic chemotherapy, and good results were achieved after chemotherapy.
Basic information】Female, 60 years old
Disease Type】Melanotic large cell lymphoma
Hospital】Binzhou Central Hospital
Date of consultation】December 2021
Treatment plan】Systemic chemotherapy (prednisolone acetate injection + injectable cyclophosphamide + injectable piroplatin hydrochloride + injectable vincristine sulfate)
[Treatment period] 4 cycles of chemotherapy
Treatment effect】All enlarged lymph nodes have subsided, the disease has been controlled, and all indexes are in the normal range
I. Initial consultation
The lymph nodes were located in the neck, supraclavicular region, axilla and groin, with hard texture and poor mobility, and some of them were fused into clusters. The patient reported that he had no recent infection such as cold or flu, no cough or sputum, no chest tightness or shortness of breath, no joint pain, no fever or night sweats, and no weight loss. At the persuasion of his family, he had consulted the local hospital, and ultrasonography suggested multiple lymph nodes enlargement, significant cortical thickening, and loss of some medullary structures, but no further diagnosis and treatment were done.
Later, the patient visited our hospital, and the possibility of lymphoma was first considered based on clinical symptoms and ultrasound tests from outside hospitals. Later, hematological examinations such as blood routine, hematocrit, hemagglutination test, liver and kidney function, and CT examination of the chest and abdomen were perfected. Through physical examination, we found that the patient’s enlarged lymph nodes were distributed in the neck, supraclavicular region, axilla and groin, with hard texture, poor mobility, no pain, and partially fused into a mass, and the preliminary diagnosis was lymphoma. According to the Ann-Arbor staging criteria, the patient had enlarged lymph nodes on both sides of the diaphragm, which was stage III. The patient was suggested to have further pathological examination.
II. Treatment history
The patient was then biopsied from the cervical lymph nodes, and the conventional pathology suggested a lymph node proliferative lesion. Immunohistochemistry and genetic testing were performed, and the patient was considered to have mesenchymal large cell lymphoma, and chemotherapy was recommended. The patient was admitted to the hospital for the second time, and the complete examination excluded the contraindication to chemotherapy, and the first cycle of chemotherapy was given, that is, the use of prednisolone acetate injection, injectable cyclophosphamide, injectable piroplatin hydrochloride, injectable vincristine sulfate systemic chemotherapy, and the patient had no significant adverse reaction to chemotherapy.
III. Treatment effect
After the 1st chemotherapy, the patient’s lymph nodes were significantly reduced, and in the 2nd cycle of chemotherapy, the patient had mild peripheral neurotoxicity after chemotherapy. The patient was readmitted for the 3rd cycle of chemotherapy, and had mild peripheral neurotoxicity after chemotherapy. In the 4th cycle of chemotherapy, a repeat CT indicated that the lesion was close to CR, and systemic chemotherapy was given again with the above-mentioned drugs. After treatment, the enlarged lymph nodes have all subsided and the disease has been controlled, and all indexes are in the normal range.
IV. Notes
1. We are glad that the patient’s condition was controlled after treatment. Advise the patient not to perform strenuous exercise after discharge, such as running, brisk walking, climbing, swimming, etc., and to rest mainly.
2, pay attention to quit smoking and alcohol, diet without spicy and stimulating, rough food, soft and easy to digest food, pay attention to supplement quality protein.
3. Learn to self-examine by palpation, observe the condition of superficial lymph nodes, and return to the hospital regularly for routine blood tests, liver and kidney functions, ultrasound, CT and other imaging tests.
V. Personal insight
1. The cell morphology of mesenchymal large cell lymphoma is special and sometimes easily confused with Hodgkin’s lymphoma, which needs to be further clarified by immunohistochemical testing. The patient may show an immunophenotype accompanied by CD30 positivity, based on which the diagnosis of mesenchymal large cell lymphoma can be made.
2. For this patient, the treatment outcome of mesenchymal large cell lymphoma is relatively good, with a five-year survival rate usually exceeding 70%. Therefore, the choice of treatment plan needs to be individualized according to the patient’s physical condition and the presence or absence of underlying diseases.