Patient History

Pathophysiology

Manifestations

Lab results

30 y/o, M, Call Center Agent

CD20 (+)

MUM1: (+)

C-Myc: (+)

BCL2 (+)

(+) painless, rubbery bilateral cervical lymphadenopathy

Largest: L supraclavicular mass

PET-CT:

multiple FDG avid bilateral cervical lymph nodes

(6.5 cm widest in diameter)

PET-CT:

(+) hypoehnancing nodules

MANAGEMENT

R-CHOP q21d x 6 cycles (± IFRT for bulky sites) with CNS prophylaxis (MTX if high-risk/ABC subtype)

GUARDED PROGNOSIS

R-CHOP: ~53–70% long-term survival

IPI 2–3: 43–51% survival

Double-expressor status → poorer outcome

Ann Arbor Staging: Stage IVB