Pictorial Case Study

THE CASE

A 54-year-old man with a history of mild depression attended for his bi-monthly review. His mental state was improving but he mentioned a lump which he had noticed in the right side of his neck two weeks ago. It was painless and he was otherwise well.

On examination, there was a 3cm x 3cm soft lump in the right supraclavicular fossa with no other associated lumps. The lump was mobile and non-tender.

Examination of the throat, nose and ears was normal and general examination revealed no other abnormality and in particular no splenomegaly.

What is the diagnosis, management and differential diagnoses?

DIAGNOSIS AND MANAGEMENT

The diagnosis is Hodgkin's lymphoma. He was referred urgently to the ENT department where he was seen the following week and a scan performed which revealed, as well as the palpable supraclavicular node, multiple other smaller nodes with features suggestive of lymphoma. A fine-needle aspiration of the lump was undertaken. The result was inconclusive so he was admitted as a day case for excision of the lump which confirmed Hodgkin's lymphoma. He was referred to the haematology department and had started chemotherapy and radiotherapy.

Hodgkin's disease is a rare cancer of the lymphatic system. It most commonly affects patients in their twenties and thirties.

POSSIBLE DIFFERENT DIAGNOSIS
- Cervical lymph node-enlarged secondary to local infection.
- Lipoma.
- Sebaceous cyst.
DIFFERENTIAL DIAGNOSIS
Cervical lymphadenopathy
- Firm, tender.
- Enlarged lymph nodes.
- Check for dental abscess or URTIs.

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