ESMO Preceptorship Programme
Clinical case
Patient P., 31 year
Daria Dubovichenko,
Medical Oncologist, Chemotherapy Department,
Arkhangelsk Clinical Oncology Dispensary, Russia
PhD student, 2nd year
the Northern State Medical University, Arkhangelsk
Radiology, Radiotherapy and Clinical Oncology department
Lymphoma 2017: Lugano, Switzerland - 03 Nov - 04 Nov 2017
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Anamnesis morbi
Patient P., 31 year, male
Since 2014 – soft, painless tumor in the right chest area. Was observed by general surgeon and, afterwards, by oncologist – no data for cancer (genesis of chest deformation – a bruise?)
2014-2016 – the tumor was growing steeply, no pain
07.2016 – CT- scan of the chest, bronchoscopy and electrocardiogram
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Anamnesis morbi (2)
CT-scan of the chest (15.07.2016): chest
tumor (sarcoma?), Mts in mediastinal
lymphatic nodes (the largest - 17 mm in
short dimension).
07.2016 – pain Gr. 2 in the tumor area
(pain controlled by admission of non-
steroid anti-inflammatory drugs)
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Status localis: Tumor 15x12 cm in the anterior chest area, solid, immobile, with local edema of the soft tissue, no pain in palpation. Enlarged right axillary lymph nodes up to 15 mm.
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ESMO PRECEPTORSHIP PROGRAM
ESMO PRECEPTORSHIP PROGRAM
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Examination
10.08.2016 – axillary lymph node biopsy.
Histology and immunohistochemistry: CD30+, CD15+, CD3-, CD20-. Hodgkin's lymphoma. Nodular sclerosis, type 2.
Chest x-ray (09.08.2016): MTI 0.31. Mass of the chest up to 13-14 cm, anterior-posterior size 10 sm.
Ultrasound examination of the abdomen (11.08.2016) – no masses revealed
EGDS (22.08.2016) – w/o pathology
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Examination (2) Chest CT-scan (25.08.2016):
Soft-tissue mass in the right part of the chest 129x110x175 mm with destruction of sternum , uneven contours, spreading to the anterior mediastinum to the pericardium (pushes the heart to the left).
Multiple enlarged lymph nodes: right mediastinal and precardial up to 71x49 mm in diameter (up to 110 mm in height), bifurcation up to 28x17 mm, bronchopulmonary up to 27x19 mm. Axillary: right 56x40mm, left 54x38mm. In the left neck side up to 19x11mm, right subclavicularup to 18x17mm, left – up to 30x24mm.
No pericardial effusion. With the exception of the sternum, no destructive changes in bone tissue have been identified. Several small foci in the right lung up to 10-12 mm.
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Examination (3) Abdomen CT-scan (25.08.2016):
Lymph nodes in the liver hilum up to 33x22
mm, 38x16 mm.
Right paragastric lymph nodes up to 11 mm,
para-aortic lymph nodes up to 13x10 mm or
less.
The liver is normally located, moderately
enlarged (+ 51HU), normal architectonics.
In the soft tissues of anterior abdominal wall
at the level of the belly button to the right -
local consolidation, irregularly shaped up to
15x8 mm in diameter (lymphoma lesion?).
Ultrasound examination of anterior
abdominal wall – without signs of lymphoma.
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Clinical diagnosis
Hodgkin's lymphoma, nodular sclerosis
with involvement of mediastinal, all groups
of peripheral and retroperitoneal lymph
nodes, invasion of soft tissues of the
chest’, sternum, lesions in right lung (by
CT scan). Stage IV AE, poor prognosis.
Hepatomegaly.
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Treatment
16.09.2016 - 27.10.20164 cycles of BEACOPP-14
CT-scan control of the chest and abdomen:
Positive dynamic
01.11.2016 - 26.12.2016 4 cycles of BEACOPP-14
25.08.2016 before treatment
24.10.2016 after 4 cycles of BEACOPP-14
19.12.2016 after 8 cycles of BEACOPP-14
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Treatment (2)
On a PET-CT scan after 8 cycles of
BEACOPP-14 – signs of metabolic activity
in the residual lesions.
The consultation of medical oncologist
recommended on possibility of high-dose
chemotherapy?
Patient didn’t appear for control
examination since 01.2017
ESMO PRECEPTORSHIP PROGRAM
Thank you for your attention!
