A Rare Case of Malignant

LymphomaKarunan Kannampoyilil

Dept of NephrologyMedical College Trivandrum

J-16/F/TVPM●+ONE Pupil with distinction●Very poor ●2004 , Devoloped edema eyes nose (3 1/2 m onths) dr.suresh●Subsides.●Dyspnoea 8 days hospitalised.●At home increased dyspnoea.●Madeena hospital-tested, told allergic●Then dr.joshy allergy of water from spring●Change to well water.●Dyspnoe vepralam came to MCH●Fever,Lip Ulcers, Edema eyes.●No other problem.●Dermatology consult.●Relieved sms.

2004 Nov-Dec●Fever,Cough,Dyspnoea,Sweating.●Edema subsides.●Normal urine.●School Examination.●Exam fever,●Sms Deteri.●Baada,booda,devil.Spirit,●With Mantravadam (Spiritual Rx).●No Relief.

Adm. teri care Center●Fever.●Tachypnoic●Tachicardia●Resp crackles●No edema●Inv,Diag,Rx

Inv●Blood●Hb-18.1;TC-20,000,;●P-80;L-14;E-6.ESR-10●Pl.Count-2.8L●RFT-N●LFT-N●HIV-Neg●HbsAg-Neg

INV●Urine●Prot-trace.●sug-nil ●M/E-no-RBC,PC●24hr UP-900mg

Pl.fluid●sug-13mg,●pr-3.7gm%,●ADA-1371u/l●LDH-2050u/l

Blood●ANA +ve●Anti.ds.DNA +ve●Rh F -Neg

USG Abd-March 7●Liver-13cm-N;GB,Pan=N●Spl-7.7cm,●RK,LK-9.3-8.3,UB-N●Gross Bil Pl effu●Rt&Lt ovary N.●Minimal fluid- POD

Pl.Fluid●Yellow,Turbid,●TC-31000●DC:N-85%,L-15%●Few Atypical Cells &RBC

Malignant Lymphoma●WHO/REAL classi(Ann oncol 1999)

●Grading; B cell & T cell●Indolant,●Aggressive,●Special.

Special●B-cellLymphblastic,Burkitt,

Primary effusion-(HHV-8 associated)

●T-CellLymphoblasticHTLV-1 associated

Staging●BCCA Ann Arbor System

Stage Involvement1 Single LN Region OR 1 Extra L site2 >2 LNR or Extr L.Exten same side-Diaphrgm.3 LNR both side diaphragm/local ext L4 Diffuse >1ELOrgan or site

Stage●Based on Sms. A or B.A =No B smsB=Presence, of one of the sms1-Unexplained Wt Loss2-UE fever3-Night SweatsBulk of TmrBulky=tmr>10cmNon bulky=<10 cm

For Rx Purp●Limited stagestage1,2,no B sms,non bulky●Advanced stagestage 2 beyond 3 adjacent LNRS3 B sms bulky tmr

Rx●Type stage age Rx1.Indolent LTD: All involved field radiation ADV: All asympt closs follow upsym+ chlorabucil or.cvp2.Aggressive chop3.Special: Emergency chemo with cns prophylaxis cyclophosphamide or multi drugRx

PrognosisAGE

●Good <60●Poor >60

Staging●For rx plan malignant

lypmphoma in to 2 groups bystage

1.LTD stage 2. ADV stage

Diagnosis●Presence of Malignant

Lymphocytes In a biopsy of LNORIn Extra Lymphatic Tissue.

FNAC-SCLN

●Few Lymphocytes &bd only

●Pl flu-Mature&transitional,lypho;occ-Nutro

Larsen regimen; blood 1998

●Cyclopho●Donorubicin●Vincristine●Pred●L-asparginase●97% ●With & without G CSF