• Created by: MazzaW
  • Created on: 06-12-19 15:22


Lymphadenopathy: location (often neck, axilla, groin), duration (refer if >6wks), usually painless, is it changing

Risk factors for HIV/TB

Contact with cats (toxoplasmosis may cause lymphadenopathy)

Any immunosuppression e.g. post-transplant

Travel history

B symptoms: weight loss, drenching night sweats

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Lymphadenopathy: size, shape, suface, mobility, consistency

Examine other lymph node areas

Examine skin for bruising (BM failure rare)

Neuro exam if indicated

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  • Initially: FBC, U+Es, LFTs, ESR, monospot test (for EBV), viral screen
  • blood film
  • cell surface markers (immunophenotyping)
  • LDH
  • B2 macroglobulins
  • toxoplasma screen
  • Igs
  • ferritin
  • CXR
  • biopsy required for Dx (FNA not enough): core biopsy may do it but if this fails, need excision biopsy

Can give steroids for treatment but caution with doing this before biopsy- makes it harder to get Dx (especially in brain lymphoma)

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Ann Arbor staging:

  • stage 1: 1 lymph node above diaphragm
  • stage 2: 2+ lymph nodes above diaphragm
  • stage 3: lymph nodes below diaphragm (or other lymph tissue)
  • stage 4: outside of lymph tissue

Most staging via PET- used for staging and end-of-treatment monitoring, difficult to interpret if infection (causes increased uptake) or diabetes

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Hodgkin's lymphoma

10% of all lymphoma

Reed-Sternberg (owl's eyes) cells on biopsy- diagnostic

Can be low-high grade.

Variable survival if untreated, but mostly curable so treat!

Treatment with chemo +/- radiotherapy. Can still cure if they relapse after 1st line Rx, so give less agressive Rx at first

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Burkitt's lymphoma

Aggressive (high grade)

Survival of only weeks if untreated

Treat with chemo +/- radiotherapy

High risk of tumour lysis syndrome- give allopurinol as prophylaxis and maintain adequate hydration

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Follicular lymphoma

Commonest form of lymphoma

Long natural history- very slow growing so sually stage IV at presentation

Stage 1 = rare but can be cured by radiotherapy alone

Can transform into high-grade non-Hodgkin's lymphoma

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Diffuse large B-cell lymphoma

2nd most common form of lymphoma. 

Can evolve from chronic lymphoid leukaemia and follicular non-Hodgkin's lymphoma

Immunohistochemistry: CD20 positive (so can give rituximab- antiCD20 monoclonal Ab)

Rapidly growing so need to treat

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