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.

2 comments:

Suheil said...

high grade lymphoma transformation that is..

Craig Chen said...

exactly!
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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.