Hodgkin’s Lymphoma
Presentation:
A 26 year old female presents to her primary care doctor with complaints of
weight loss, feeling of “tightness” in her chest, night sweats, fatigue, and
persistent, non-productive cough times one month. She has a low grade fever
of 99.5, but all other vital signs are within normal limits. Her oxygen
saturation is normal, as is her breathing pattern, despite her complaints of
chest heaviness. Her medical history is notable only for a tonsillectomy at
age 7.
Differential Diagnoses:
Solid tumor cancer (likely lung), lymphoma, lung infection such as
pneumonia, bronchitis, anxiety disorder with physical manifestations
Diagnosis:
A physical assessment is performed and the patient is noted to have swollen
axillary lymph nodes. CBC with differential, CMP, ESR, and blood cultures
are ordered. An EKG is obtained, and a 2 view chest x-ray is ordered. The
EKG shows normal sinus rhythm. The lab work shows an elevated WBC,
particularly lymphocytes, and an elevated ESR. The blood cultures are
negative, ruling out infectious process. The chest x-ray shows a large, 12
cm mediastinal mass. The doctor orders a biopsy of the mass. The tissue
pathology shows a presence of Reed-Sternberg cells, confirming a diagnosis
of Hodgkin's lymphoma. The doctor then orders a PET scan to detect the
presence of spread of the disease. There is found to be spread to several
other lymph nodes in the body. The patient is diagnosed with Stage 3B
Hodgkin's lymphoma.
Treatment:
The patient’s treatment begins with radiation to the chest to shrink the
size of the bulky tumor. The patient receives a 6 week course of radiation.
Afterwards, the oncologist further treats this patient with the standard
chemotherapy for her diagnosis, which is the ABVD regimen. This regimen
includes adriamycin, bleomycin, vinblastine, and decarbazine. The chemo
regimen is a 4 week cycle, and the patient receives a total of 6 cycles.
Outcome:
Following the combination therapy of radiation and chemotherapy, the patient
has a repeat PET scan performed. She is found to be in complete remission
from her disease. She will follow up with repeat PET scans every 6 months
for a total of two years, at which time she will be followed up on a yearly
basis.
Case created by Lauren Seck, 2010.