Made by: reham Talal Khalil Asmaa Mohamed alghefari Case 8 : - Made by: reham Talal Khalil Asmaa Mohamed alghefari

a 64-y.o o comes to your office of pain in the chest & coughing you ordered a roentgenogram showed a “mass” in the mediastinum. an excisional biopsy was performed diffuse large b-cell lymphoma on farther investigation multiple inguinal & iliac lymphadenopathy

Non Hodgkin Lymphoma Aggressive Indolent B cell Follicular Burkitt Hairy cell leukemia/lymphoma Mantle cell Waldenestrom Macroglobulinemia Precursor T lymphoblastic B lymphoblastic

Aggressive Can Be Trait By Chemotherapy * Aggressive Can Be Trait By Chemotherapy * Non Aggressive Can Be Trait By Observe (Watch, Wait).

- B cell lymphoma The most common aggressive lymphoma - Could Be:- - B cell lymphoma The most common aggressive lymphoma   - Could Be:- * De novo * From abreviously indolent lymphoma   Some are Associated EBV - Can be nodel and extranodel   - Median age 65 Y.O

When CLL becomes DLBCL Richter syndrome due to rapid cell turnover in DLBCL can have tumor lysis syndrome high ka , ureic acid in the blood but, low ca, LDH usually high .

How diagnose LDBCL   -excisional biopsy the architecture of the node and cell appearance -CBC and blood chemistry (LDH) will be high uric acid will be high > high grade NHL -HIV testing -staging physical exam and CT scan - pet scan . help diagnose and follow up -if use immunobiological stain.cd 20

Thank you