lymphoma involving the mediastinum

[bharat]

A 20 -year old male present in the emergency department with a lymphoma involving the mediastinum that is producing respiratory distress.
The lymphocytes are most likely to have cell surface markers characterstic of which of the following.?
A. B Lymphocyte.
b. T Lymphocyte.
c. Macrophage.
d. Dendritic reticulum cells.
e. Langgerhans cell.

[Oak]

Originally Posted by bharat

A 20 -year old male present in the emergency department with a lymphoma involving the mediastinum that is producing respiratory distress.
The lymphocytes are most likely to have cell surface markers characterstic of which of the following.?
A. B Lymphocyte.
b. T Lymphocyte.
c. Macrophage.
d. Dendritic reticulum cells.
e. Langgerhans cell.

bharat I would go for A, I think its Primary Mediastinal B-cell lymphoma.

Primary mediastinal B-cell lymphoma (PMBL) is a diffuse large B-cell lymphoma that arises in the thymus and mainly affects young adults.

PMBL was recognized as a specific entity in the Revised European-American Classification of Lymphoid Neoplasms (REAL) and accounts for approximately 5% of all patients with aggressive lymphomas, a frequency roughly similar to that of Burkitt disease and lymphoblastic lymphoma.

New evidence suggests that this disease may resemble Hodgkin disease more so than other types of large B-cell lymphoma. Because of its skewed age distribution, PMBL accounts for a much higher proportion of both younger patients and those undergoing autologous transplantation. Fifty to eighty percent of patients are cured with a modern intensive combination chemotherapy that is often followed by involved field radiation or autologous transplantation.

[bharat]

Originally Posted by Oak

bharat I would go for A, I think its Primary Mediastinal B-cell lymphoma.

Primary mediastinal B-cell lymphoma (PMBL) is a diffuse large B-cell lymphoma that arises in the thymus and mainly affects young adults.

PMBL was recognized as a specific entity in the Revised European-American Classification of Lymphoid Neoplasms (REAL) and accounts for approximately 5% of all patients with aggressive lymphomas, a frequency roughly similar to that of Burkitt disease and lymphoblastic lymphoma.

New evidence suggests that this disease may resemble Hodgkin disease more so than other types of large B-cell lymphoma. Because of its skewed age distribution, PMBL accounts for a much higher proportion of both younger patients and those undergoing autologous transplantation. Fifty to eighty percent of patients are cured with a modern intensive combination chemotherapy that is often followed by involved field radiation or autologous transplantation.

well this time i have diffrent explanation. It is like this..
Correct ans. is B. T-lymphocyte because
T cell lymphomas occuring in the thoracic cavity in young patients usually arise in the mediastinum and have a particularly aggressive clinical course with rapid growth in the mediastinum impinging upon the trachea or mediastinum bronchi and leading to the marked respiratory deficiency, which can in turn lead to death in a relatively short period of time if not treated.
This unique lymphomas are characterised by rapid cell growth & spread in to the circulation where they produce elevated total white cell count reflacted by circulating lymphomas cell.
As T cell they have characterstics of rossete formation with SRBC.
T-cell also have CD4 helper & CD8 supressor t-cell surface antigen,the tumor cell also express IL-2 receptor
while Fc receptor occur in B-cell & macrophage, class II HLA antigen can be alsofound on macrophage,Langerhanes cell & dendritic reticular cells.
well if you want description please refer to- "Cortan, page no.654-658,661-662)

[Oak]

Originally Posted by bharat

well this time i have diffrent explanation. It is like this..
Correct ans. is B. T-lymphocyte because
T cell lymphomas occuring in the thoracic cavity in young patients usually arise in the mediastinum and have a particularly aggressive clinical course with rapid growth in the mediastinum impinging upon the trachea or mediastinum bronchi and leading to the marked respiratory deficiency, which can in turn lead to death in a relatively short period of time if not treated.
This unique lymphomas are characterised by rapid cell growth & spread in to the circulation where they produce elevated total white cell count reflacted by circulating lymphomas cell.
As T cell they have characterstics of rossete formation with SRBC.
T-cell also have CD4 helper & CD8 supressor t-cell surface antigen,the tumor cell also express IL-2 receptor
while Fc receptor occur in B-cell & macrophage, class II HLA antigen can be alsofound on macrophage,Langerhanes cell & dendritic reticular cells.
well if you want description please refer to- "Cortan, page no.654-658,661-662)

90% of lymphomas are B-cell therefore, T-cell lymphoma 10% only which is rare. I just went according to its incidencce which is 90% for B Cell lymphoma. Yup bharat you are right. I missed age and the sex.

Yh, I missed it, only diagnostic clue was the age... since both B & T lymphomas can present with the sortness of breath due to mediastinal involvement. I missed one thing is that median age for B cell lymphomas is 30 yrs which I overlooked and for whereas T Cell Lymphoma is quite common in young males. Where as B cell in Female.