Non-Hodgkin's lymphoma

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A 50 yr old Chinese man complained of a rapidly enlarging painless neck mass.  He had no other symptoms.   Physical examination revealed no pallor, jaundice or skin haemorrhages.  There was a 2cm diameter, large, non-tender, firm swelling on the right side of the neck.

1.    What is the differential diagnosis?

Differentials include:

-     Primary lymph node disorders

-     Metastasis carcinoma

-     Reactive hyperplasia

-     Inflammation / infections

-     Lipid storage diseases

-     Endocrine diseases � hyperthyroidism

2.    What other parts of the body would you examine before submitting the patient to a biopsy?

Other lymph nodes: axillary, inguinal

Spleen, liver � check for enlargement

3.    What are the key histopathological features?

No Reed Sternberg cells.

Irregular lymphocytes with large number of mitoses

Complete effacement of lymph node architecture

4.    How would you determine the T or B lymphocyte lineage of the tumour cells?

Immunophenotyping � monoclonal Ab against specific cell surface markers

e.g. CD 20 � B cells

       CD 3 � T cells

5.    How aggressive do you think the lesion shown is likely to be?

These cells are small cells, indicating they are mature, non blastic hence indolent and less aggressive.

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Copyright � Joseph Ong 2003