Lymphadenopathy and Splenomegaly Flashcards
(20 cards)
What is the history of splenomegaly?
Variable:
- Nil complaints
- Aware of mass
- Fullness and LOA
- Extreme pain (splenic infarct)
- Splenic rupture
What is the differential for splenomegaly?
Infection
- Viral (EBV, CMV, HIV)
- Bacterial (IE, TB, brucellosis)
- Parasitic (malaria, bilharzia)
Infiltration
- Malignancy (myeloproliferative, lymphoproliferative)
- Amyloidosis
- Storage disease (Gaucher’s disease)
Inflammatory
- RA
- SLE
- Sarcoidosis
Congestive
- Cirrhosis
- Portal vein thrombosis
Haemolytic anaemia
What are the causes of massive splenomegaly?
CML
Idiopathic myelofibrosis
Lymphoma
Hairy cell leukaemia
Gaucher
Thalassaemia
Malaria
Kala Azar (not in RSA)
How does the FBC help in finding the cause of splenomegaly?
Normal -> bone marrow cause less likely, but can be lymphoma
Pancytopaenia -> hypersplenism or marrow involvement
How does a blood smear help in finding the cause of splenomegaly?
Leucoerythroblastic picture: (infiltrationof bone marrow)
- nucleated RBC
- blasts
- tear drop cell
What does the leukoerythroblastic picture look like?
Picture
What does hairy cell leukaemia look like?
Picture
Indolent, chronic, low grade leukaemia
What does CML look like?
Picture
Lots of neutrophils
Early granulocyte precursors
What does CLL look like?
Picture
Small Lymphocytes
When is splenectomy used?
Emergency:
- Traumatic rupture
- Spontaneous rupture
Therapeutic:
- ITP/ AIHA
- Hereditary spherocytosis
- Splenic marginal zone lymphoma
- Large painful spleen
- Hypersplenism
Diagnostic
High risk of thrombosis, infection, and life-threatening malaria/babesiosis
What is the differentiation process of blood cells?
Picture
What are the myeloproliferative neoplasms?
CML - Philadelphia chromosome t(9:22)
Ph- negative:
- Polycythemia Vera (incread Red cell production)
- Essential Thrombocythemia (increase platelet production)
- Primary myelofibrosis (increased fibroblast growth factor)
- can have JAK2V627F mutation
- splenomegaly and constitutional symptoms
- terminal phase pancytopenia and massive spleen
- can transform into AML
What is the approach to lymphadenopathy?
Age
Onset
Size - increasing?
Systemic symptoms
Symptoms of infection/malignancy
HIV status
Medication
What is the work up for lymphadenopathy?
FBC and smear
HIV
Tests for Systemic disease
Node biopsy
How are lymphoproliferative disorders classified?
Leukaemia
Bone marrow origin
- Acute
- Chronic (CLL, HCL)
Lymphoma
Origin in nodes or spleen - bone marrow involved in advanced stage
What are the types of lymphoma?
Hodgkin
Non-Hodgkin
- B cell
- Low grade (follicular)
- High grade (diffuse large cell, Burkitt, plasmablastic)
- T cell
- Low grade
- Aggressive
What is CLL?
Slow growing, indolent
Commonest leukaemia
Night sweats, fatigue, anaemia, low platelets, lymphadenopathy, splenomegaly
Early finding may be incidental - might not require treatment (may not progress)
High risk of infection
What is seen on node biopsy in Hodgkin lymphoma?
Picture
What is Hodgkin lymphoma?
Slow growing - very good prognosis and cure rate in early stage
Can be aggressive in advanced stage
High incidence in advanced HIV
Managed with combination chemo and radiation to bulky nodal areas
Relapse can be cured with chemo and stem cell transplant if responsive
How do lymph nodes biopsies work?
Should be given to everyone with unexplained lymphadenopathy
- Empiric TB therapy given to HIV + patients with lymphadenopathy
Fine-needle biopsy can diagnose TB or metastatic ca, but not lymphoma
Core biopsies can be done with biopsy gun
- can diagnose lymphoma
- can be excised if not diagnostic
- can diagnose
Biopsy the most representative node
