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Mevr W., geboren in 1974

Mevr W., geboren in 1974. 2001 klieren in de hals;langzaam groter 2005 Duidelijke toename; verwijzing internist. Diagnose: Folliculair lymfoom (graad1) met lokalisaties in hals,oksels, para-aortaal, para- iliacaal en beenmerg (stadium4)

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Mevr W., geboren in 1974

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  1. Mevr W., geboren in 1974 • 2001 klieren in de hals;langzaam groter • 2005 Duidelijke toename; verwijzing internist. Diagnose: Folliculair lymfoom (graad1) met lokalisaties in hals,oksels, para-aortaal, para- iliacaal en beenmerg (stadium4) Geen klachten→ expectatief (“wait and see”) • Okt 2006 Duidelijke progressie kliergrootte, moe en last klier rechts t.p.v. clavicula:behandelindicatie • Jan 2007 Oogst eicellen na hormonale stimulatie. 7 bevruchte eicellen ingevroren

  2. Mevr W., geboren in 1974 • Mrt 2007 - Start immuno-chemotherapie (R-CVP) in kader internationale studie (PRIMA) . - na 3 kuren: geen effect - Pijnlijke klier li. Lies : bestraald (2x2Gy) • Aug 2007 - Start 2e lijns therapie: R-FCM (6x). - na 3 kuren: goede partiële remissie • Jan 2008 - na 6 kuren: complete remissie • Feb 2008 - start onderhoudsbehandeling rituximab: 1x/3 mnd. Max 2 jaar (tot feb. 2010)

  3. Mevr W., geboren in 1974 • Mei 2010 - opname i.v.m ernstige H.Influenzae pneumonie bij hypogammaglobulinemie (IgG 2.7 g/l) - AB/ start gammaglobuline 1x/maand • Juli 2010 - zwanger!

  4. Malignant Lymphomas • tumours of the immune system • malignant counterparts of normal (mature) lymphocytes

  5. non-Hodgkin Lymphomas Incidence • Overall ~ 10-15 / 100.000 / year • Age dependent • Increasing • Risk factors • chemicals :hair dyes; herbicides • irradiation • immunodeficiency (cong. / acquired)

  6. non-Hodgkin lymphoma : Epidemiology • incidence females 10 / 100,000 / yr, males 15.3 /100,000/ yr • mortality females 4.8 / 100,.000/ yr males 7.6/ 100,.000/ yr

  7. non-Hodgkin LymphomasClinical Features • Enlarged lymph nodes • > 80%, often multifocal • Enlarged liver and / or spleen • Extranodal tumours • GI tract, CNS... (diversity in symptoms ! ) • B symptoms • fever, weight loss, night sweats Diagnosis: lymph node biopsy

  8. non-Hodgkin LymphomasClinical Features

  9. non-Hodgkin lymphoma

  10. non-Hodgkin LymphomasDiagnostic work-up Pathology • Prof Pals.....

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