Fay Shall is a 52 year old woman who has presented to clinic feeling tired all the time. She has not noticed many other symptoms - initially she put this down to low mood. However she feels that her mood is 'absolutely fine' at the moment and does not feel stressed at all. She is struggling to sleep, as she feels she is really struggling with the menopause - she wakes up in the night absolutely drenched in sweat. These hot flushes are really affecting her sleeping pattern. She also has noticed that she has lost about 2 stone in weight over the past 3 months, though she has just picked up a new 'FitBit', so reckons it may be down to that.
On examination, she looks pale. Her chest sounds clear, and her abdomen is soft, non tender. She has splenomegaly, and you note an enlarged, non-tender, supraclavicular lymph node. She is pyrexial: her temperature is 38.1 degrees celsius.
Initial blood tests come back as the following:
Hb 131
WCC 10.2
Urea 6
Creatinine 87
ESR 76
You note she had a positive monospot test three years ago.
Over to you - what would you like?
Chest X Ray report: evidence of intrathoracic lymphadenopathy and clear mediastinal expansion - *inform cancer trackers*
HIV Screen: NEGATIVE
Evidence of multinucleated giant cells (Reed-Sternberg cells) in histology sample
No evidence of BJP
Now select your winner!
You picked:
Correct answer:Lymphoma
A number of concerning symptoms jump out here immediately: weight loss and night sweats. This could be related to menopause: it is at an appropriate age. Turning to examination, splenomegaly may suggest haematological malignancy. Leukaemia, myeloma and lymphoma would be of consideration here: however the WCC count would lend itself to lymphoma. There is no raised urea or Bence Jones Protein which would be suggestive of myeloma. Lymph node biopsy demonstrates Reed-Sternberg cells: associated with Hodgkin's lymphoma.
