Medical case reports serve as detailed accounts of individual patient journeys, offering insights into specific medical conditions and their management. These narratives contribute to the broader medical knowledge base, helping healthcare professionals understand unusual disease presentations or responses to treatment. They provide real-world perspectives that complement larger clinical studies, often highlighting observations that can inform future research or clinical practice. This article presents an anonymized patient’s experience with lymphoma, tracing their path from the onset of symptoms through diagnosis, treatment, and long-term monitoring.
Patient’s Initial Symptoms and Presentation
The patient, previously healthy, first noticed a persistent, low-grade fever, often spiking in the evenings, accompanied by drenching night sweats. These recurred over several weeks without clear cause.
Unexplained weight loss, approximately 10% of their body weight over six months, also raised concerns, as there were no changes in diet or exercise. A swollen, firm, and painless lymph node emerged in the neck, persisting for several weeks, unlike typical swollen glands.
The combination of these systemic symptoms and the enlarging lump prompted medical evaluation. The patient also experienced increasing fatigue that did not improve with rest.
The Diagnostic Journey
The medical evaluation began with a thorough physical examination and routine blood tests. The physical exam confirmed the enlarged, painless neck lymph node, but initial blood work provided no definitive answers. This suggested further investigations were needed.
Imaging studies followed, starting with a computed tomography (CT) scan of the chest, abdomen, and pelvis. This scan revealed enlarged lymph nodes in the neck, chest, and abdomen, indicating widespread involvement. A positron emission tomography (PET) scan combined with a CT scan (PET/CT) was then performed to assess metabolic activity. This advanced technique uses a radioactive tracer absorbed by metabolically active cancer cells, illuminating the disease’s full extent.
The PET/CT confirmed highly active cancerous lesions in multiple lymph node regions above and below the diaphragm, and bone marrow involvement. While imaging provided strong evidence, a definitive diagnosis required a biopsy. An excisional biopsy of the enlarged neck lymph node was performed, where the entire lymph node was surgically removed for pathological examination. Microscopic analysis confirmed Diffuse Large B-cell Lymphoma (DLBCL), a common and aggressive non-Hodgkin lymphoma. Based on biopsy results and widespread disease, the lymphoma was classified as Stage IV, indicating involvement in multiple lymph node areas and at least one organ outside the lymphatic system.
Formulating and Executing the Treatment Plan
Following the diagnosis of Stage IV Diffuse Large B-cell Lymphoma, a multidisciplinary team of oncologists developed a comprehensive treatment strategy. The standard-of-care regimen, R-CHOP, was selected. This regimen combines five distinct agents, each targeting cancer cells through different mechanisms:
Rituximab: A monoclonal antibody targeting the CD20 protein on cancerous B-cells, prompting immune destruction.
Cyclophosphamide: A chemotherapy drug that damages cancer cell DNA, inhibiting growth.
Hydroxydaunorubicin (Doxorubicin/Adriamycin): A chemotherapy agent interfering with enzymes necessary for cancer cell replication.
Oncovin (Vincristine): A chemotherapy drug preventing cancer cell division.
Prednisone: A corticosteroid reducing inflammation and enhancing other drugs’ effects.
The patient began six R-CHOP cycles, administered every 21 days. On day one of each cycle, intravenous medications (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine) were given over several hours in an infusion center. Prednisone was taken orally for five days following the infusion. Proactive measures managed anticipated side effects, including anti-nausea medications and growth factor support to maintain white blood cell counts and reduce infection risk.
Response to Treatment and Long-Term Monitoring
Upon completing R-CHOP chemotherapy, the patient underwent a post-treatment PET/CT scan to assess therapy effectiveness. This scan detects remaining metabolically active cancer cells, providing a comprehensive picture of disease status. Results were favorable, showing no evidence of active lymphoma in previously affected areas. This outcome signified complete remission, with no detectable signs of active disease.
Achieving complete remission is a significant milestone, but long-term monitoring remains an ongoing aspect of care. The patient entered a surveillance phase, involving regular follow-up appointments with their hematologist-oncologist. Initially, these appointments were monthly for the first year, gradually extending to every few months. During visits, the medical team conducted physical examinations, reviewed blood work, and discussed any new symptoms.
The primary goal of this follow-up is to monitor for lymphoma recurrence, most likely within the first two years. Routine imaging, such as repeat PET/CT scans, is not always performed unless clinically indicated due to potential false positives and radiation exposure. However, periodic CT scans of affected areas may be conducted, typically at 6, 12, and 24 months post-treatment. This surveillance also allows for identification and management of potential long-term chemotherapy side effects.