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A 62 year old male with swelling in neck

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Mind Map on A 62 year old male with swelling in neck, created by hamda ali on 24/03/2019.
hamda ali
Mind Map by hamda ali, updated more than 1 year ago
hamda ali
Created by hamda ali over 5 years ago
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Resource summary

A 62 year old male with swelling in neck
  1. Swelling in neck diffrential diagnosis
    1. Cingenital
      1. Thyroglossal cysts
      2. Developmental
        1. Branchial cysts
        2. Skin and subcutaneous tissue
          1. Lipooma
          2. Thyroid swellings
            1. solitary thyroid nodule
            2. Salivary glands tumors
              1. Pleomorphic adenoma
              2. Tumors of parapharyngeal space
                1. deep lobe parotid
                2. Reactive neck lymphadenopathy
                  1. Tonsilitis
                  2. Malignant neck node
                    1. metastases
                      1. Lymphoma
                        1. Neoplastic proliferation oflymphoid cells that forms a mass; may arise in a lymph node or in extra nodal tissue
                          1. Lymphnode
                            1. Lymph Node Development
                              1. The lymph sacs are transformed into groups of lymph nodes in early fetal life, at about the third month, except the upper portion of the cisterna chyli, which persists.
                                1. The mesenchymal cells will give rise to the lymph node capsule and the connective tissue framework of the node.
                                2. Lymph Node distribution
                                  2. Lymph Nodes of the Neck
                                    2. major site of B and T lymphocytes
                                      1. Histology of the Thymus
                                        1. Site of T-cell differentiation and maturation
                                          1. Located in the anterosuperior mediastinum
                                            1. Encapsulated
                                              1. Cortex dense with immature cells
                                                1. Medulla pale with Mature Tcells and Hassal corpuscles (Reticular cells)
                                                2. Lymphocytes Functions
                                                  2. Lymphadenopathy
                                                    1. Acute infections
                                                      1. Chronic infections (Cat Scratch Disease).
                                                        1. Primary or secondary tumors
                                                          1. Autoimmune Diseases.
                                                      2. Risk Factors
                                                        1. Epstein-Barr virus infection/mononucleosis
                                                          1. Age & Gender
                                                            1. Family history
                                                              1. Weakened immune system
                                                                1. Exposure to certain chemicals and drugs
                                                                  1. Infections that directly transform lymphocytes
                                                                    1. HTLV-1
                                                                      1. EBV
                                                                        1. HHV-8
                                                                      2. Hodgkin vs. Non-Hodgkin Lymphoma
                                                                        1. Classification
                                                                          1. Hodgkins Lymphoma
                                                                            1. Classic Hodgkins Lymphoma
                                                                              1. Nodular Sclerosis type\ Mixed cellularity\ Lymphocyte Rich\ Lymphocyte Depleted
                                                                              2. Nodular Lymphocyte predominant Hodgkins lymphoma
                                                                              3. Non-Hodgkin Lymphoma
                                                                                  1. Relation Between Non-Hodgkin Lymphoma and Leukemia
                                                                                    1. Chronic lymphocytic leukemia
                                                                                      1. Similar to small-cell lymphocytic lymphoma
                                                                                        1. Transform into diffuse large B cell lymphoma by Richter transformation
                                                                                          1. Richter transformation is common in chronic lymphocytic leukemia with deletion 17p, or trisomy21 or NOTCH1 mutations.
                                                                                        2. Adult T cell leukemia\lymphoma
                                                                                          1. It is T cell non-Hodgkin lymphoma that is caused by HTLV1
                                                                                            1. there is lymphocytosis in blood.
                                                                                        3. Aggressive non-Hodgkin lymphomas
                                                                                          1. Account for 60 % of all non-Hodgkin lymphomas
                                                                                            1. Younger patents
                                                                                              1. More B symptoms
                                                                                                1. Short natural history
                                                                                                  1. Median survival rate (1-2 years).
                                                                                                  2. Indolent non-Hodgkin lymphomas
                                                                                                    1. Account for 40 % of all non-Hodgkin lymphomas.
                                                                                                      1. Older patients.
                                                                                                        1. Few B symptoms.
                                                                                                          1. Long natural history.
                                                                                                            1. Median survival rate (7 to 10 years).
                                                                                                        3. Diagnosis
                                                                                                          1. Excisional biopsy
                                                                                                            1. Immunohistochemistry
                                                                                                              1. Flow cytometry
                                                                                                                1. CD 19, CD20 for B cell lymphomas
                                                                                                                  1. CD 3, CD 4, CD8 for T cell lymphomas
                                                                                                                  2. Chromosome changes
                                                                                                                    1. 4;18 translocation in follicular lymphoma (bcl-2 oncogene)
                                                                                                                      1. t(8;14), t(2;8), t(8;22) in Burkitt lymphoma (c-myc oncogene)
                                                                                                                        1. t(11;14) in mantle cell lymphoma (cyclin D1 gene)
                                                                                                                      2. Staging
                                                                                                                        1. Blood tests
                                                                                                                          1. Bilateral bone biopsy & aspirate
                                                                                                                            1. Lactic dehydrogenase, beta-2 microglobulin levels
                                                                                                                              1. Chest x-ray, CT scan
                                                                                                                                1. PET
                                                                                                                                  1. Lumbar puncture in case of : AIDS NHL
                                                                                                                                  2. Management
                                                                                                                                    1. First-line treatment for stages I & II
                                                                                                                                      2. First-line treatment for stages III & IV
                                                                                                                                        2. Follow-up care

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