All Wales Lymphoma Panel Lymphoma Course April 2015 Wales Millennium Centre Cardiff

Transcription

1 All Wales Lymphoma Panel Lymphoma Course April 2015 Wales Millennium Centre Cardiff Case Histories Online slides at: Professor Sebastian Lucas Case SL1 SP : MSM male aged 28 years. Presented with cervical lymphadenopathy. HIV test +. CD4 = 25; HIV VL = 500,000. Lymph node biopsy. Case SL2 OC : British male 57 years old. HIV-ve. Presented with pancytopaenia, abnormal LFTs, and splenomegaly. Splenectomy performed. Marrow biopsy done before the splenectomy. Case SL3 OC : Male 40 years. HIV+ve, with low CD4 count and high HIV VL - poorly compliant with cart. Splenomegaly and night sweats. HHV8 VL = 2.2 million copies per ml blood. Groin node biopsy. Case SL4 PMH12210: 26-year-old Filipino nurse working in UK. HIV-ve. Became ill with non-specific symptoms and fever. Admitted to hospital. Deteriorated into SIRS and multi-organ failure, dying with no diagnosis in life in ITU 16 days after the onset of illness. All microbiology negative. At autopsy: nothing to see apart from slightly enlarged mediastinal lymph nodes. Autopsy bone marrow. Case SL5 PM14: Male HIV-2+ve, died after treatment for pulmonary tuberculosis [image of autopsy lung #244 - same diagnosis - provided]. Hilar lymph node at autopsy. Case SL6 PM294: Male HIV+ve, died of overwhelming infection. Mesenteric lymph node, at autopsy [image #294 provided].

2 Case SL5 PM14 Macro [image of autopsy lung #244] Case SL6 MP294 Macro [image #294] 2

3 Professor Falko Fend Case FF1 K24187/14: 7-year-old girl, polypous lesion in the rectum. Case FF2 C139/14: 84-year-old female, massive tumorous infiltration of omentum. Case FF3 K4434/11: 62-year-old female. 12 mm tumor in the breast. Case FF4 C38/15: 55-year-old woman with parotid swelling. Case FF5 K21185/14: 75-year-old female, 4.5 cm soft, whitish mass in the liver. Case FF6 K30674/13: 61-year-old female; 2.5 cm nodule in the parotid region. Professor Leticia Quintanilla de Fend Case LQ1 K2740/11: A 25-year-old woman presented with mediastinal mass. A needle-biopsy was performed. (biopsy submitted) Case LQ2 AS272/11: A 26-year-old man presented with mediastinal mass extending to lung parenchyma. A needle biopsy was performed. (biopsy submitted) Case LQ3 K9204/12: A 17-year-old woman presented with cervical lymphadenopathy. (LN biopsy submitted) Case LQ4 K27963/11: An 88-year-old man presented with submandibular lymphadenopathy. (LN biopsy submitted) Case LQ5 K31041/13: A 36-year-old man was diagnosed in 2006 with FL grade III in transformation to DLBCL stage IV A. The patient was treated with 6 cycles R-CHOP achieving complete remission. In 2013 presented with inguinal lymphadenopathy. (LN biopsy submitted) Case LQ6 K17944/14: A 74-year-old woman presented with fatigue and anemia. A CT-scan demonstrated a retroperitoneal tumor (16 cm. bulky disease). A needle biopsy was taken. (biopsy submitted) Case LQ7 K3771/14: A 24-year-old woman from Dubai presented with enlarged mediastinal lymph nodes, thymus and right thyroid. A lymph node biopsy was taken. (LN biopsy submitted) 3

4 Dr Zbigniew Rudzki Case ZR : Male, 57. Presented with hyperleukocytosis (WCC 120), basophilia (11), thrombocytosis (862), anaemia and splenomegaly. Case ZR : Male, 37. CML diagnosed 9 months earlier, presented with accelerated phase-type features. No expected cytogenetic response to Nilotinib and Bosutinib (99/100 granulocytes BCR/ABLl+ by FISH), although currently nearly-normal PB counts. Allogeneic SCT planned. Case ZR : Male, 69. Rheumatoid arthritis treated with TNF-inhibitor Etanercept. Neutropenia since April 2014, nadir 0.5xl0 9 /L, currently ~0.9. BM aspirate - no dysplasia or excess of blasts, but of ringed sideroblasts. Mild anaemia (Hb 12g/dL) and monocytosis ( since 2012, but occasionally monocytes drop to normal, no clear trend). Nothing particular on BM flow cytometry. Case ZR : Male, 74. Indolent B-cell lymphoma diagnosed in 2009 but never classified (details not available). Recently apparently disease progression, but at present no accessible information about the current status of the disease: no FBC available. Case ZR : Male, 61. CLL diagnosed in 2000, relapses and multiple treatments; recently completed BR, currently on Idelalisib/placebo maintenance study. Response recorded as excellent, but remains anaemic (Hb 96g/L) and thrombocytopenic (plt ~50xl0 9 /L). ~1% CLL MRD on BM flow cytometry, nothing sinister on recent BM aspirate. Recently skeletal lesions found on imaging following presentation with right shoulder pain. Case ZR : Male, 59. Archival outside trephine bone marrow biopsy (2011). originally reported as showing no signs of any myeloproliferative neoplasm (had erythraemic presentation back then). Reviewed recently when care transferred to our institution. Has JAK2 exon 12 mutation. Case ZR : Male, 83. Thrombocytopenia (50-80x10 9 /L) recorded in April 2014; 2012 and earlier counts normal. Minimal anaemia. lymphopenia, neutrophilia (~llxl0 9 /L) and monocytopenia. BM flow cytometry of myeloblasts. 4

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