How to Answer Hodgkin Hodgkin Lymphoma Questions (Complete Guide)
This question tests key academic concepts commonly covered in coursework.
What This Question Is About
This question relates to hodgkin hodgkin lymphoma and requires a structured academic response.
How to Approach This Question
Start by identifying the main issue, then apply relevant academic frameworks.
Key Explanation
This topic involves hodgkin hodgkin lymphoma. A strong answer should include explanation, application, and examples.
Original Question
Hodgkin and Non-Hodgkin Lymphoma 02 Scenario Dx 2021-2024 EOD, Summary Stage, Grade, SSDI Mashup (Closes for CEs various dates – pending) Abstracted Text Physical Exam 07/01/2021 – Pt w/ 1 month of hx of worsening headache, orbital pain, facial pressure, and oral numbness. Pt notes in past few days, headache has become intractable. Pt has been experiencing fatigue but has no weight loss, fevers, or night sweats. PE: Neck: No masses. Oral cavity: No obvious mass or lesion. No palp LAD. Plan: Imaging. 08/10/2021 – Med-Onc Note: DLBCL. Pt is considered low risk anatomically as there is only one extra-nodal lesion measuring <10 cm, but we consider pt high risk for CNS involvement given involvement of the maxillary sinus. Per discussion at Tumor Board, would recommend pt undergo rads, followed by R-CHOP. Scans 07/02/2021 - CT Head: Findings: Lobular, expansile soft tissue mass in the Lt maxillary sinus measuring up to 6.9 x 5.7 cm w/ mass effect on the maxillary sinus walls. Mass effect on the Lt orbit without clear involvement of the orbit or optic nerve. Mass encroaches Lt pterygopalatine fossa. No cavernous sinus involvement. No LAD or masses in neck. IMP: Maxillary sinus tumor. 07/12/2021 - MRI Brain: Findings: Recently dx'd high grade B-cell lymphoma. Lt maxillary sinus soft tissue mass w/ minimal extension into Lt pterygopalatine fossa. Mass abuts Lt orbital floor superiorly w/o orbital or optic nerve involvement. No imaging evidence of intracranial/cavernous sinus extension. 07/14/2021 - CT Chest/Abd/Pelvis: IMP: No LAD or distant mets identified. 07/14/2021 - CT Neck: IMP: Lt maxillary sinus mass is incompletely visualized and better described on previous CT or MRI. Several prominent small cervical lymph nodes seen in Lt level III, but there is no frank LAD identified by CT criteria. 07/14/2021 - PET/CT: IMP: Hypermetabolic mass centered in Lt maxillary sinus, c/w known lymphoma, measuring 6.7 cm. No hypermetabolic LAD or distant mets from base of skull to mid-thigh. Labs 07/12/2021 - HIV: Non-reactive. Operative Reports 07/05/2021 - Lt Anterior orbitotomy w/ Lt maxillary sinus lesion bx (Procedure only). Treatment Plan 08/04/2021 - Rad-Onc Consult: Will start external beam rads next week, with plan to start systemic treatment after rads complete. Radiation Text 08/12/2021 - Lt maxilla treated w/ 1000 cGy 3D conformal rads, 200 cGy per fraction (x 5 fractions). Dates given: 08/12/2021 - 08/18/2021. Chemo Text 08/27/2021 - Started R-CHOP. Hormonal Text 08/27/2021 - Started R-CHOP. Immuno Text 08/27/2021 - Started R-CHOP. Stage 08/04/2021 - Rad-Onc Note: Stage IE DLBCL of maxillary sinus. NCCN IPI Risk Group: Low-intermediate risk DLBCL (IPI Score 2). 07/05/2021 - Path Report #1 FINAL DIAGNOSIS LEFT MAXILLARY SINUS LESION, BIOPSY: 1. Large B-cell lymphoma with a high Ki-67-defined proliferative rate (see Comments) 2. Pending FISH studies to evaluate for a MYC, BCL2, and BCL6 gene rearrangement COMMENT The overall findings reflect involvement by a large B-cell lymphoma with a high Ki-67-defined proliferative rate of greater than 95%, and there is no evidence of an associated low-grade lymphoma component in these biopsies. The neoplastic cells are EBV-negative by EBER-1 in-situ hybridization, so this is not an EBV-driven process. Unstained sections of the tissue have been forwarded for FISH studies to evaluate for potential rearrangements of the MYC, BCL2, and BCL6 genes, to allow further molecular subclassification of this B-cell lymphoma. The FISH results and a final diagnosis will be reported in an Addendum when the FISH studies are completed. In addition to the immunophenotype provided by the immunohistochemical studies in this case, the concurrent flow cytometric evaluation on the left maxillary sinus lesion indicates that the abnormal B-cell population is lambda light chain-restricted with expression of low-level CD19 and intermediate CD38. ADDENDUM DIAGNOSIS 1. Diffuse large B-cell lymphoma (DLBCL) with a high Ki-67 proliferative rate (greater than 95%). ADDENDUM COMMENT FISH studies performed on the left maxillary sinus lesion are negative for a MYC, BCL2, and BCL6 gene rearrangement; however, the fluorescent signal patterns with the BCL2 probe reveal one to two extra fused copies of the BCL2 gene, indicating the presence of a chromosome 18 abnormality. An extra fluorescent signal was also noted with an IGH probe, indicating the presence of a chromosome 14 abnormality other than fusion with MYC. The absence of rearrangements of the MYC, BCL2, and BCL6 genes by FISH excludes a so-called "double hit" large B-cell lymphoma; and the neoplastic cells are negative for EBV by EBER-1 in-situ hybridization, excluding an EBV-driven lymphoma. The overall findings reflect involvement by a diffuse large B-cell lymphoma (DLBCL) with a high Ki-67-defined proliferative rate of greater than 95%, and there is no evidence of an associated low-grade lymphoma component in this biopsy. Given the collection of findings in this case, this patient's lymphoma may exhibit a more aggressive clinical behavior than a typical DLBCL, so close clinical follow-up is recommended. EOD Primary Tumor img EOD Regional Nodes img EOD Mets img Summary Stage 2018 img Grade Grade Clinical img Grade Post Therapy Clin img Grade Path img Grade Post Therapy Path img Site-Specific Data Items (SSDI) B Symptoms img HIV Status img NCCN Int'l Prog Index img code the following
******CLICK ORDER NOW BELOW AND OUR WRITERS WILL WRITE AN ANSWER TO THIS ASSIGNMENT OR ANY OTHER ASSIGNMENT, DISCUSSION, ESSAY, HOMEWORK OR QUESTION YOU MAY HAVE. OUR PAPERS ARE PLAGIARISM FREE*******."
