History
In 2019, a 81-year-old retired history professor is admitted to the emergency room after fainting in the rest rooms of a restaurant. He sustained a profusely bleeding laceration on the left side of his head that requires stitching.
Clinical exam: patient in a relatively good general state of health for his age. Normal blood pressure 130/80, pulse 72, 178 cm, 69 kg, oxygen saturation is 93% on room air. ECG within normal limits. The chest x-ray shows a relevant pleural effusion.
Laboratory shows a discrete blood lymphocytosis and a low normal haemoglobin of 130 g/L. Liver and kidney function is within normal limits.
Previous history: arterial hypertension since 1991, aortic valve replacement with a biologic valve in 2003.
Current medication: valsartan 180 mg, lercarnidipin 10 mg, acetylsalicylic acid 100 mg
A diagnostic workup is performed. The cytometry of the pleural tap reveals a clonal B-cell population. A PET/CT-scan finds bilaterally enlarged cervical, axillary, mediastinal, retroperitoneal and inguinal lymph nodes as well as nodes in the pectoral and dorsal muscles. A pectoral adenectomy is characterised by a Mib1 20%, CD20+, CD79a+, CD5+, CD43+, Bcl2+, Cyclin D1+, CD10-, Bcl6- (figures 1 a–e) cell population concordant with a mantle cell lymphoma (MCL) stage IV with an MCL International Prognostic Index (MIPI) at 4.
Treatment options are discussed.
Figures 1 a–e: Results of the immunohistochemistry of the patient in 2019.
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