A 34 year-old man arrives to the emergency department because of fever, neck pain, and a rapidly enlarging right cervical lymph node. He first noticed the lymph node growing bigger 3 weeks ago. The patient has no significant medical history and takes no medications.
On exam, his temperature is 101.5 °F, blood pressure is 128/76 mm Hg, pulse is 114 beats per minute, and respiration rate is 16 breaths per minute. Upon inspection of the nect, a 17-cm firm, non tender enlarged right cervical lymph node is palpated. Examination of the abdomen reveals no splenomegaly and the remainder of the examination is unremarkable.
Labs:
Complete blood count Normal
Creatinine 1.1 mg/dL
Lactate dehydrogenase 850 U/L
Phosphorus 5.5 mg/dL
Potassium 5.0 mEq/L
Urate 8.1 mg/dL
CT scans of the neck and chest showed 20 cm enlarged right cervical lymph node that is displacing the trachea to the left. Then a biopsy of the node was taken. The results came back positive for CD20-positive Burkitt lymphoma.
Treatment with hydration, furosemide, and allopurinol are initiated.
Which of the following is the most appropriate additional treatment?
A. Perform a tracheostomy
B. Start the patient on clarithromycin, amoxicillin, plus omeprazole
C. Initiate rituximab plus hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (R-hyper-
CVAD)
D. Consult surgery for debulking surgery followed by radiation therapy
E. Start the patient on radiation therapy
Reference:
Molyneux EM, Rochford R, Griffin B, et al. Burkitt's lymphoma. Lancet. 2012 Mar 31;379(9822):1234-44. PMID: 22333947
Answer is here:
https://steemit.com/steemstem/@rsc227/medical-challenge-question-10-cancer-answer
Downvoting a post can decrease pending rewards and make it less visible. Common reasons:
Submit