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Abstract: A 30-year-old young male presented with recurrent fever with neck mass within 1 month and poor results of triple cephalosporin treatment. After consultation, he was initially diagnosed with cervical lymph node enlargement by physical examination, blood count, and neck ultrasound. Later, through biopsy, the diagnosis of mesenchymal large cell lymphoma was confirmed. Subsequently, through chemotherapy + autologous hematopoietic stem cell transplantation, the patient’s symptoms were relieved and his condition was controlled.
Basic information】Male, 30 years old
Disease Type】Megamorphic large cell lymphoma
Hospital】The Second Hospital of Guangzhou Medical University
Date of Consultation】January 2022
Treatment Plan】Chemotherapy
Treatment Period】6 courses of chemotherapy, 21 days per course; 1 month of hospitalization for autologous bone marrow transplantation
Treatment effect】Efficacy evaluation was complete remission (CR)
I. Initial interview
The patient is a young male with a history of smoking and staying up late. He came to the oncology department with “recurrent fever for 1 month and neck mass for 1 week”. He was diagnosed as bronchopneumonia and given antipyretic drugs and cephalosporin III anti-infection treatment, but the fever still recurred. 1 week ago, he unintentionally felt a mass on the left side of his neck, and there was no pain on pressure, so he came to our oncology department for consultation. Subsequently, he underwent relevant examinations, and his blood count was normal; chest X-ray showed no abnormality; ultrasound examination of the neck showed multiple enlarged lymph nodes in the neck bilaterally, the largest one being 3.0×2.5 cm.
II. Treatment history
The patient was admitted to the hospital, consulted by the general surgery department, and underwent “partial biopsy of cervical lymph nodes” under local anesthesia, and the postoperative pathological diagnosis was: mesenchymal large cell lymphoma, ALK positive. Bone marrow aspiration and biopsy did not suggest bone marrow invasion of lymphoma. In order to clarify the diagnosis of lymphoma stage, whole-body PET/CT scan was recommended, but the test was expensive and not reimbursed by medical insurance. The whole-body PET/CT scan indicated multiple lymph node invasion throughout the body, and the stage was stage III. Therefore, the patient was finally diagnosed with “mesenchymal large cell lymphoma, ALK-positive, stage IIIB”. After diagnosis, the patient was treated with CHOEP (C: cyclophosphamide; H: doxorubicin; O: vincristine; E: etoposide; P: prednisone tablets), and has been treated with 6 courses of chemotherapy.
III. Treatment effect
After 2 courses of chemotherapy, the patient’s recurrent fever disappeared and physical examination showed that the enlarged lymph nodes in the neck were significantly reduced; after 3 courses of chemotherapy, the enlarged lymph nodes in the neck could not be felt at all, and CT scan + enhancement examination of the neck + chest + abdomen showed that most of the multiple enlarged lymph nodes in the whole body dissipated, and the efficacy evaluation was partial remission (PR). She has completed 6 courses of chemotherapy and is preparing for the 7th course of chemotherapy.
IV. Notes
We are glad that the patient’s disease is under control after chemotherapy. Since mesenchymal large cell lymphoma is a malignant tumor that can easily recur, patients must pay special attention to their body changes after discharge from the hospital, including indicators such as body temperature, changes in the size of lymph nodes in the neck, and even weight changes. They need to frequently test their body temperature and touch themselves from time to time to check superficial areas, such as the neck, armpits, and upper and lower clavicles, for the presence of masses and rapid weight loss. In addition, the patient’s diet after chemotherapy discharge should be high in protein and low in fat, clean and hygienic, easy to digest, and avoid spicy and greasy. Finally, the instructions of the doctor in charge were especially observed, regular outpatient review and timely return to the hospital for further consultation and treatment.
V. Personal insight
Mesenchymal large cell lymphoma is a malignant lymphoma with relatively low incidence and rapid growth. It has high malignancy, but the early symptoms are mild and not easy to detect, therefore, most patients are at advanced stage (stage III-IV) when diagnosed, with poor treatment effect and low survival rate of patients. Therefore, as medical workers, it is our responsibility to popularize relevant scientific knowledge of the disease and improve the prognosis of the disease by increasing the rate of early diagnosis and treatment. The treatment of malignant lymphoma is a long-term systemic project, and obtaining the cooperation of patients and their families is very important for the treatment effect, and it is a very effective way to maintain communication with patients and or their families all the time during the consultation and treatment.