Lymphoma case

• Lymphoma cases, either Non-Hodgkins or Hodgkin’s, need the following workup.

Clinical Examination:

1. Do a careful examination of the lymph node, spleen, liver and etc.

Blood workup:

1. Total leukocytes (TLC).
2. Differential leukocyte count (DLC).
3. Hemoglobin
4. Erythrocyte sedimentation rate (ESR)
5. Platelet count.

Bipedal lymphangiogram.

1.  This is done for iliac and para-aortic lymph nodes.

Staging laparotomy:

1. Laparoscopy can be done for splenectomy, liver biopsy, abdominal lymph nodes, and bone marrow biopsy.

Biochemical tests are:

1. Needed are Liver function test (LFT) and lactate dehydrogenase (LDH).

Ultrasonography.

1. CT scan and MRI are advised for further workup.

Advised liver and spleen scan.

1. 25% positive in the nonpalpable spleen by the pathologist.
2. 50% negative in the palpable spleen by the pathologist.

Bone Marrow

1. 9 to 29% may show as aggregates or diffuse infiltrates of lymphoma cells.
2. 25% positive in the nonpalpable spleen by the pathologist.
3. 50% negative in the palpable spleen by the pathologist.

• Now because of modern advances in medical science, now staging laparotomy is not needed.

Lymphoma case  summary of the workup:

1. Clinical evaluation of the patient:
   1. A thorough physical examination is needed.
   2. Take the detailed history of the patient.
   3. Ask for any other disease present in these patients.
2. Imaging studies:
   1. Imaging is very important to find the spread of the diseases.
   2. Imaging studies avoid staging laparotomy.
   3. Various imaging techniques are:
      1. CT scan (Computed tomography). It will evaluate the lymphadenopathy and any other organs involved.
      2. PET scan (positron emission tomography). This study is done with the injection of radioactive material. It will detect the involvement of the lymph nodes throughout the body.
      3. MRI (magnetic resonance imaging). It is helpful to detect the lymphoma in the brain and spinal cord.
      4. X-Ray is done for specific areas of the body. X-Ray, especially for the chest, for nodal and pulmonary disease.
3. Lab workup:
   1. Advise complete blood count.
   2. Advise liver and kidney function tests.
   3. Lactate dehydrogenase (LDH) helps as a marker and gives a prognosis.
   4. Advise tumor marker for follow-up of the patient.
4. Bone marrow examination for the infiltrate of the lymphoma.

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