Wednesday, December 2, 2009

Earthquake Magnitudes

A 75 year old man with diabetes, coronary artery disease, dyslipidemia, COPD, diverticulosis, untreated chronic lymphocytic leukemia diagnosed 3 years ago, and a history of CVA 5 years ago presents with new onset of fever, night sweats, and weight loss. Examination shows abdominal lymphadenopathy, and splenomegaly. Labs show an increased lactate dehydrogenase, anemia (Hgb 10.5 g/dL), and thrombocytopenia (plts 80,000/mcL). Biopsy of a lymph node is shown below:

Challenge: This finding was described in 1928. What new diagnosis does he now have?

Image is shown under GNU Free Documentation License.


Suheil said...

high grade lymphoma transformation that is..

Craig Chen said...

Earthquake Magnitudes

This is a Richter's transformation, development of an aggressive large-cell lymphoma (usually B-cell) in the setting of underlying chronic lymphocytic leukemia or small lymphocytic lymphoma. The histology here shows a diffuse large B-cell lymphoma. Prognosis is poor.

Source: UpToDate; Wikipedia.