Anaplastic lymphoma - with CT biopsy

Case contributed by Dr Ian Bickle

Presentation

Lethargy and vague abdominal pain.

Patient Data

Age: 70
Gender: Female
Ultrasound

An ultrasound abdomen at a distant health care facility identified para-aortic lymphadenopathy.

Biateral para-aortic lymphadenopathy - the skin surface markers are present to aid planning for biopsy.

The equipment for the job.

Skin surface markers - usually not commercially available, one can make one by cutting up an angiographic catheter (as shown).

Extensive bilateral para-aortic lymphadenopathy, biopsied under CT control.

Co-axial needle in position in the right paraspinal region, prior to core biopsy of the right para-aortic lymph node

Case Discussion

The initial CT chest, abdomen and pelvis revealed bilateral para-aortic lymphadenopathy.   No primary source was detected.  No supra-diaphragmatic lymphadenopathy.

CT guided biopsy with a 18G co-axial needle performed with the patient in the prone position.

This offered the safest, most assessible route for the least invasion way to make a definitive diagnosis.   

With the co-axial needle tip 'parked' just before the chosen lymph node, with a 2cm throw, the renal vessels draped over the anterior aspect of the lymph node are not in danger.

Histopathological analysis confirmed a anaplastic lymphoma.

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Case information

rID: 21643
Published: 6th Feb 2013
Last edited: 24th Mar 2018
Inclusion in quiz mode: Included

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