Presentation
2 weeks right upper quadrant abdominal pain, progressive; associated with fever and jaundice; tenderness and guarding over the right upper abdomen.
Patient Data
Gallbladder wall edema however no specific features to suggest acute cholecystitis.
Splenomegaly, pathologically enlarged gastrohepatic and portacaval lymph nodes and indeterminate retroperitoneal lymph nodes, ascites.
Left-sided axillary lymphadenopathy measuring up to 2 cm short axis diameter. No other thoracic lymphadenopathy identified.
Bilateral pleural effusion, more on the right. Bibasal atelactasis, more on the right.
The central airways appear unremarkable.
No filling defect seen in the pulmonary arterial tree.
The heart, large vessels and mediastinum appear unremarkable.
Differentials include hematological malignancy and atypical infection.
There has been an improvement in appearances.
Previously demonstrated upper abdominal adenopathy has reduced in bulk and there is no abnormal, measurable nodal disease at this site.
Nodes in the left axilla are smaller with a residuum measuring 1 cm in short axis. No enlarged nodes are present elsewhere in the thorax nor either side of the neck.
Abdominopelvic ascites has resolved. The spleen has reduced in size now measuring 14.6 cm in craniocaudal extent.
There is no hydronephrosis. Small, uncomplicated left renal calculi.
No focal bony abnormality.
No new adverse findings.
Case Discussion
The patient proceeded initially to ultrasound guided left axillary nodal core biopsy, and subsequently excision biopsy of a left axillary node.
The histology and immunohistochemistry together confirmed T-cell lymphoma with some features consistent with angioimmunoblastic lymphoma.
The patient subsequently has completed intensive chemotherapy (CHOP regime) with evidence of disease response namely reduction in spleen and nodal disease volume. He is currently under follow up.
Case courtesy of Dr Joshua Bell, Dr Rachel Hyland and Dr Sarah Swift.
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