Toxoplasmic Cervical Lymphadenopathy Precedes Lymphoma

Abstract

A 35 years old male presented to the outpatient clinic in Alexandria University Hospital with right neck swelling appeared 1 year ago and finally diagnosed, 9 months ago, by histopathologists in the same institute via ultrasound guided FNAC, as Toxoplasmic lymphadenitis. However, the patient represented by sudden increase in the size of this mass 3 months before this re-attendance associated with malaise and low grade fever but there was neither night sweat nor weight loss. The patient had a clear evidence of contact with cats because he was a veterinarian. There was no other positive family, surgical or medical history. On examination, large, firm, mobile right sided lymphadenopathy without signs of active inflammation in the overlying skin at levels III, IV and V. No evident lymph nodes on the other side of the neck or other sites of his body and no hepatoslenomegaly. Temperature and vital signs were normal. ENT examination did not warrant any additional abnormality Erythrocyte Sedimentation Rate (ESR) was 95mm/hr and LDH was 300 U/l these were the first red flag signs that directed the team to further evaluations for Lymphoma. Open surgical biopsy finally diagnosed it as grade III follicular non-Hodgkin’s Lymphoma through the Light microscopy which revealed grade III follicular NHL (>15 large centroblasts/high-power field) and DNA analysis which showed t (14; 18) chromosomal translocation characterized by fusion of the bcl-2 gene at 18q21 with the immunoglobulin heavy chain locus at 14q32