LegendX
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Hi guys, do all leukemias/lymphomas cause generalised lymphadenopathy?
I was slightly confused as to how to tell the difference between hogkins lymphoma and CML as they both cause lymphadenopathy right?
I understand you can do biopsy and look for reid stein berg cells etc but in terms of signs? --?? do both cause generalised lymphadenopathy?
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Helenia
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Not always generalised in lymphoma - you usually get it in specific groups of nodes first. Staging and prognosis is based on how many groups of nodes are involved. The only way to definitively diagnose Hodgkin's from non-Hodgkin's is with histology. You can have a guess based on the patient demographics and sometimes the location (cerebral/other extra-nodal disease is more usually NHL) but only histo will be definitive.

Leukaemia does not always cause lymphadenopathy.
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LegendX
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(Original post by Helenia)
Not always generalised in lymphoma - you usually get it in specific groups of nodes first. Staging and prognosis is based on how many groups of nodes are involved. The only way to definitively diagnose Hodgkin's from non-Hodgkin's is with histology. You can have a guess based on the patient demographics and sometimes the location (cerebral/other extra-nodal disease is more usually NHL) but only histo will be definitive.

Leukaemia does not always cause lymphadenopathy.
Hi, thanks for replying. I was confused because of this question i came across:
A 38-year-old woman presents in the Emergency Department with a one-month history of painful enlargement of her cervical and axillary lymph nodes, lethargy and severe oral ulceration. On examination, she has gross cervical, axillary and inguinal lymphadenopathy associated with splenomegaly. He blood film shows ‘occasional blast cells’. The diagnosis is subsequently confirmed on lymph node biopsy

The answer was CML, i can understand that CML manifests in adults generally but why is the diagnosis confirmed by LYMPH node biopsy and not bone marrow biopsy? I thought lymph node biopsy was taken or lymphomas?
Also, is the lymph node enlargement due to metastasise in this case?
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Helenia
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(Original post by LegendX)
Hi, thanks for replying. I was confused because of this question i came across:
A 38-year-old woman presents in the Emergency Department with a one-month history of painful enlargement of her cervical and axillary lymph nodes, lethargy and severe oral ulceration. On examination, she has gross cervical, axillary and inguinal lymphadenopathy associated with splenomegaly. He blood film shows ‘occasional blast cells’. The diagnosis is subsequently confirmed on lymph node biopsy

The answer was CML, i can understand that CML manifests in adults generally but why is the diagnosis confirmed by LYMPH node biopsy and not bone marrow biopsy? I thought lymph node biopsy was taken or lymphomas?
Also, is the lymph node enlargement due to metastasise in this case?
Leukaemias, particularly CML and CLL, can affect lymph nodes, but not always. Leukaemia doesn't really "metastasise" exactly, as it's in the blood, but the lymphadenopathy is due to cancerous cells proliferating within the nodes. I think the blast cells is the key here - you don't get those in lymphoma (I think), though it's not a completely clear-cut question.

As for why it was diagnosed on LN biopsy rather than BM - probably as much down to practicality as anything else. If there are easily palpable nodes, it is easier and less painful to do a needle aspiration or core biopsy than it is to do a bone marrow aspirate/biopsy. They may sample bone marrow later anyway for prognostic purposes, but they also do this for lymphoma.
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LegendX
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(Original post by Helenia)
Leukaemias, particularly CML and CLL, can affect lymph nodes, but not always. Leukaemia doesn't really "metastasise" exactly, as it's in the blood, but the lymphadenopathy is due to cancerous cells proliferating within the nodes. I think the blast cells is the key here - you don't get those in lymphoma (I think), though it's not a completely clear-cut question.

As for why it was diagnosed on LN biopsy rather than BM - probably as much down to practicality as anything else. If there are easily palpable nodes, it is easier and less painful to do a needle aspiration or core biopsy than it is to do a bone marrow aspirate/biopsy. They may sample bone marrow later anyway for prognostic purposes, but they also do this for lymphoma.
Thanks!
One more question if you don't mind me asking: melanoma can metastasise to which LOCAL lymph nodes? and which general lymph nodes?
Its a random question i know but I came across it and my thoughts were cervical + supraclavicular but i honestly have no idea for what to put.
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Helenia
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(Original post by LegendX)
Thanks!
One more question if you don't mind me asking: melanoma can metastasise to which LOCAL lymph nodes? and which general lymph nodes?
Its a random question i know but I came across it and my thoughts were cervical + supraclavicular but i honestly have no idea for what to put.
Melanoma would metastasise to whichever nodes drain the area the tumour is situated in. So if it's on the leg, it would spread to groin nodes, on the arm to axillary nodes etc. Not sure what they mean by "general lymph nodes."
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hoonosewot
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(Original post by LegendX)
Hi, thanks for replying. I was confused because of this question i came across:
A 38-year-old woman presents in the Emergency Department with a one-month history of painful enlargement of her cervical and axillary lymph nodes, lethargy and severe oral ulceration. On examination, she has gross cervical, axillary and inguinal lymphadenopathy associated with splenomegaly. He blood film shows ‘occasional blast cells’. The diagnosis is subsequently confirmed on lymph node biopsy

The answer was CML, i can understand that CML manifests in adults generally but why is the diagnosis confirmed by LYMPH node biopsy and not bone marrow biopsy? I thought lymph node biopsy was taken or lymphomas?
Also, is the lymph node enlargement due to metastasise in this case?
Question answered comprehensively above but as a side note, if you're given a little write up case of lymphoma in an exam, 99 times out of 100 they will give you 2 or 3 of the classic "B" symptoms, those being:

Drenching night sweats (having to change the sheets overnight)
Unexplained weight loss
Fever

Plus they'll probably throw in lymphadenopathy/splenomegaly O/E to help you out.

That said, if you see those 3 symptoms mentioned, just check the story for signs of TB before you go for lymphoma. It's a classic differential question.

For example:
1: A 35 year old lady of South Asian origin presents to you with a 3 month history of night sweats and unexplained weight loss. O/E you note she has palpable lymph nodes in her neck. She has not travelled since visiting family in Mumbai a couple of years ago.

vs

2: A 65 year old lady presents to you with a 3 month history of severe night sweats which are causing her to change her sheets at night. She has also noted that she has been losing weight over the last few weeks. When you examine her you note she has some palpable lymph nodes in her axillae. She has no other symptoms of note and no other relevant history.
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Helenia
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(Original post by hoonosewot)
Question answered comprehensively above but as a side note, if you're given a little write up case of lymphoma in an exam, 99 times out of 100 they will give you 2 or 3 of the classic "B" symptoms, those being:

Drenching night sweats (having to change the sheets overnight)
Unexplained weight loss
Fever

Plus they'll probably throw in lymphadenopathy/splenomegaly O/E to help you out.

That said, if you see those 3 symptoms mentioned, just check the story for signs of TB before you go for lymphoma. It's a classic differential question.

For example:
1: A 35 year old lady of South Asian origin presents to you with a 3 month history of night sweats and unexplained weight loss. O/E you note she has palpable lymph nodes in her neck. She has not travelled since visiting family in Mumbai a couple of years ago.

vs

2: A 65 year old lady presents to you with a 3 month history of severe night sweats which are causing her to change her sheets at night. She has also noted that she has been losing weight over the last few weeks. When you examine her you note she has some palpable lymph nodes in her axillae. She has no other symptoms of note and no other relevant history.
Shamefully, when my husband (then boyfriend) got Hodgkin's, I kept thinking of him as an MCQ stem - a 25 year old white male presents with six weeks of painless, rubbery cervical lymphadenopathy, fatigue and generalised itching... and wondering how many people would "get it."
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The Only Rivo
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This slide is from a haematology revision lecture by an ST6. Hope it helps.

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inthevale
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Lymphadenopathy in HL is usually confluent and the classic nodes are cervical, axillary, mediastinal. In NHL and leukaemias the lymphadenopathy can be in different parts of the body, so you might get an MCQ that will mention cervical and inguinal lymphadenopathy. Massive splenomegaly is usually associated with CML (M for massive).
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nexttime
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(Original post by Helenia)
I think the blast cells is the key here - you don't get those in lymphoma (I think), though it's not a completely clear-cut question.
If you have peripheral blasts you have leukaemia by definition.

Technically lymphoma is any tumour of lymphoid origin so lymphocytic leukemias are also lymphomas.
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Helenia
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(Original post by nexttime)
If you have peripheral blasts you have leukaemia by definition.

Technically lymphoma is any tumour of lymphoid origin so lymphocytic leukemias are also lymphomas.
I thought so, re. the blasts, but couldn't be bothered to look it up.

I think CLL fits quite nicely in with the lymphomas, but ALL is really quite different, even if technically it's the same "family."
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