Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Surgery Final Year Case Presentation Hodgkins Lymphoma Clinical Examination Discussion and Treatment
farmer by occupation presenting with
chief complaints of multiple swellings
in both sides of neck and axilla for 2
months
History of presenting illness
Patient was apparently normal 2 months
back after which he developed multiple
swellings in both sides of neck and
axilla
insidious in onset,initially small
in size, gradually progressive and to
attain current size,
not assosiated with discharge
and pain
h/o fever for 2 days,low
g rade,continuous,not associated with
chills and rigor,relieved by medication
No h/o night sweats
No h/o loss of weight and loss of
appetite
No h/o itching
No h/o chronic cough , swelling of face ,
breathlessness
No h/o abdominal pain , swelling of legs
No h/o evening rise of temperature
No h/o oral ulcers
No h/o ear pain,ear discharge,
No h/o bleeding from nose,nasal block
No h/o abdominal pain, hemetemesis,melena
No h/o swollen testis
no h/o hoarseness of voice
No h/o difficulty in turning head
No h/o deviation of tongue
No h/o frequent fainting
No h/o difficulty in shrugging of shoulders
No h/o swelling elsewhere in the body
Past history
No h/o similar complaints in the past
No h/o TB ,DM , HT, asthma, epilepsy,
jaundice , IHD, STD
No h/o any drug allergy
No h/o previous surgeries
Personal history
Patient consumes non-veg diet
No addictive habits
Normal bowel and bladder habits
Patient denies h/o extra marital contact
Family history
No relevant family history
General examination
Patient is conscious ,oriented ,
moderately built , moderately
nourished
pallor+
No icterus
No cyanosis
No clubbing
No pedal edema
Significant lymphadenopathy
(neck ,axilla , inguinal)
Vital signs:
PR-76/min,regular in rhythm,normal
volume,no specific character,no radiofemoral,
radioradial delay, equally felt on both sides in
all palpable peripheral vessels ,no vessel wall
thickening
RR-18/min, abdominothoracic type
BP-130/80 mm Hg in right upper limb,sitting
posture
Afebrile.
Examination of neck nodes:
? Inspection
? Multiple neck nodes involving cervical
nodes upto level V, on both sides , which
includes submental , submandibular,
upper,middle and lower deep cervical and
posterior cervical nodes
? Each node measuring 2x2cm,
hemispherical in shape, largest node in
upper deep cervical node of 3x3 cm.
? Smooth surface
? No scars ,sinuses,dilated veins,visible
pulsations
Palpation
Not warm, not tender,
Inspectory findings of site , size, shape are
confirmed
Rubbery in consistency ,
Freely mobile,
Discrete,
Not fluctuant
Skin over the swelling pinchable
Plane of swelling ? deep to deep fascia
Examination of axillary nodes:
Inspection
? Multiple axillary nodes involving
central group of nodes on both sides
? Each node measuring 2x2cm,
hemispherical in shape
? Smooth surface
? No scars ,sinuses,dilated veins,visible
pulsations
Palpation
Not warm, not tender,
Inspectory findings of site , size, shape are
confirmed
Rubbery in consistency ,
Freely mobile,
Discrete,
Not fluctuant,
Skin over the swelling pinchable
Plane of the swelling- deep to deep fascia
Examination of inguinal nodes:
Inspection
? Multiple inguinal nodes involving
superficial horizontal group of nodes on
both sides
? Each node measuring 2x2cm,
hemispherical in shape
? Smooth surface
? No scars ,sinuses,dilated veins,visible
pulsations
Palpation
Not warm, not tender,
Inspectory findings of site , size, shape are
confirmed,
Rubbery in consistency ,
Freely mobile,
Discrete,
Not fluctuant,
Skin over the swelling pinchable.
No other palpable lymph nodes
elsewhere in the body
(epitrochlear,para-aortic,popliteal )
Oral cavity- no tonsillar enlargement
OTHER SYSTEMS
Examination of abdomen : soft,not tender, no
palpable mass, no organomegaly , no free fluid ,
hernial orifices are free ,external genetalia normal.
Examination of RS : Normal vesicular breath sounds
heard. No added sounds
Examination of CVS:S1 S2 heard,no murmurs
Examination of CNS:No focal neurological deficit
Examination of Spine and Cranium:Normal
Perrectal examination to be done
Diagnosis
Generalised lymphadenopathy for
evaluation involving cervical group of
lymph nodes from level I to level V ,central
group of axillary lymph nodes, superficial
horizontal group of inguinal lymph nodes
probably Hodgkin's lymphoma of stage
IIIB
Differential diagnosis
Non hodgkin's lymphoma
Tuberculous lymphadenitis
Secondaries neck
HIV(AIDS Complex)
Leukemia
syphilis
MANAGEMENT
INVESTIGATIONS
Routine:
Blood: TC, DC ,ESR ,Hb%, Blood
grouping/typing ,urea ,sugar ,creatinine.
Urine: sugar ,albumin ,deposits
X ray chest
ECG
Specific investigations:
USG Neck
FNAC of lymph node
Excision biopsy of lymph node
Mantoux test
CT head and neck
MRI
PET scan
Triple endoscopy
Colonoscopy
Treatment
Since it belongs to stage IIIB Hodgkin's
lymphoma(according to cotswold's
staging), the treatment is
chemotherapy-ABVD regimen
This post was last modified on 08 August 2021