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Case #4

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Asymptomatic 65-year-old male with bilateral axillary lymph node masses noted on retirement physical.

Expand Physical Exam

10/10/XX

Bilateral axillary nodes palpable. 1.5 x 6.0 cm right inguinal mass fixed to fascia. Smaller nodes also palpable on R grouped into 7 x 4 x 3 cm mass. Left groin nodes palpable. No abdominal masses.

Expand Imaging

10/14/XX

Chest CT scan: no mediastinal or bronchial adenopathy
Liver scan: hepatomegaly
Lymphangiogram: lymphoma in inguinal, pelvic, and periaortic nodes

Expand Endoscopy

Not done

Expand Operation

11/06/XX

Abdominal exploration w/excision, right groin nodes and right axillary lymph node dissection

Expand Pathology

11/06/XX

Inguinal lymph nodes: nodular histiocytic lymphoma.
Right axillary lymph nodes: rule out nodular histiocytic lymphoma. [Review at Stanford University Medical Center: Follicular large cell lymphoma.]

Expand Treatment

11/21/XX

Started R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone)
Radiation therapy planned after patient returns from vacation.