? Lymphoma

67 years,old male with history of loss of appetite since,last 3 months- On examination- Pallor + , right cervical lymph node mass , Hb - 5.4 after 2 units of blood transfusion. Earlier 10 days,back Hb was 4.2 gm% . ESR - 142 X- RAY CHEST COPD changes and bilateral minimal pleural effusion. F.N.AC of neck lymph node mass only shows narcotic material- AFB staining negative. ULTRASOUND ABDOMEN- Normal except.mild splenomegaly . CECT chest - Bilateral pleural effusion with basal atelectasis .Significantly heterogenously enhancing medistinal lymphadenopathy . Considering medistinal lymphadenopathy and significantly raised ESR - 142 . Two possibilities are there 1.Tuberculosis 2.Lymphoma - could be DLBCL Considering the Lockdown- patient was investigated in private set up - what next to differentiate between tuberculosis or lymphoma. Empirically, I have started ATT . Only good centers can do CT guided medistinal lymph node biopsy - to rule out Lymphoma .Do bone marrow examination have a role . Even s.protein electrophoresis was done to rule out multiple myeloma which was normal

a nine year old girl with history of cough, high grade fever since 4 months with chills and rigor with pain in body with h/o epistaxis with hb- 4 ,platelet count 26000 tlc 17700 chest b/l ronchi . on Att for abdominal Koch's. pallet with tachycardia. ps- anisopoikilocytosis macrocytic anaemia. h/o multiple joint pain. petechiae all over face since 5 days. USG Abdomen shows hepatomegaly. CERVICAL ADENITIS tender. likely d/d and management.

18 yr old ,girl,college student,from neighbouring state,presented with painless swelling rt side of neck since 2 yrs *Chief Complaints* She developed neck swelling rt side 2 yrs ago Initially only single nodule ,slowly, the number of nodules increased.Denied having pain ,loss of weight or appetite / fever.The swelling is remaining static for the last 1 yr. Evaluated at her home town in different hospitals,biopsy done twice. After the biopsy she was informed that there is no further treatment available .She has no primary neurological problem.The reason to visit in the OPD is asking for a help to ref her to a proper doctor for further possible management at least for cosmetic reason. *History* No significant medical illness in the past.No family history of any type of malignancy .No history of TB in the family. *Vitals* Afebrile. BP110/ 60 mmhg.HR76/ mt. *Physical Examination* The only abnormality in physical exam is multiple mobile lymph nodes,varying in size,2 to 4 cm in the rt side of neck including submandibular lymph node ,some of them are matted together.No tenderness noted. No other lymphnode noted. No hepato-spleenomegaly noted. *Investigations* All blood work up including peripheral smear ,bone marrow,blood biochemistry,immunoelectrophoresis were normal.Ct chest and abdomen were normal. Cervical lymphnode biopsy done ,this is the3rd biopsy. *Diagnosis* 1st two biopsy report: Rosai Dorfman disease. *Management* Management waiting for the biopsy report. Question : What is the possible diagnosis ?

#CPL_ROYALS Name this characteristic appearance of spleen and in which condition is it seen?

### 35 years old lady presents to OPD with fever daily since last 6 years. Associated with rigor on and off. Associated with generalized weakness and loss of appetite. She looks ill. Took medications OTC and from doctors also but in vain. She even got IV antibiotics (Inj. Xone, as per her talks) but no improvement. Her MP Optimal is negative and her Widal test is also negative. Her WBC count is within normal limits. But her ESR is raised much. Her DLC is within normal limits in one report and in another report her Eosinophil count is raised, RBC count is decreased (but Hb normal) and PCV decreased slightly. RE Urine is also within normal limits. Her serum uric acid and RBS are also within normal limits. She also complains of passage of white discharge per vagina. Also she complains of dry cough. How to approach and manage this case ??? What might be the diagnosis ??? What further investigations should be recommended to arrive at the diagnosis for proper treatment of this case ???