An 80-year-old man is reviewed in the haematology clinic. He has been referred due to weight loss, lethargy and a significantly elevated IgM level. Recent bloods show the following:
Given the likely diagnosis, which one of the following complications is he most likely to develop?
Correct Answer D: IgM paraproteinaemia - ?Waldenstrom's macroglobulinaemia.
This patient has Waldenstrom's macroglobulinaemia. Hyperviscosity syndrome is present in around 10-15% of patients. Other common complications include hepatosplenomegaly.
Waldenstrom's macroglobulinaemia: Waldenstrom's macroglobulinaemia is an uncommon condition seen in older men. It is a lymphoplasmacytoid malignancy characterized by the secretion of a monoclonal IgM paraprotein.
Features:
A 64-year-old woman with metastatic breast cancer is brought in by her husband. Over the past two days she has developed increasingly severe back pain. Her husband reports that her legs are weak and she is having difficulty walking. On examination she has reduced power in both legs and increased tone associated with brisk knee and ankle reflexes. There is some sensory loss in the lower limbs and feet but perianal sensation is normal.
What is the most likely diagnosis?
Correct Answer A: The upper motor neuron signs point towards a diagnosis of spinal cord compression above L1, rather than cauda equina syndrome.
Spinal cord compression:
Spinal cord compression is an oncological emergency and affects up to 5% of cancer patients. Extradural compression accounts for the majority of cases, usually due to vertebral body metastases. It is more common in patients with lung, breast and prostate cancer.
Management:
Which one of the following is least associated with thymomas?
Correct Answer E:
Thymoma:
Thymomas are the most common tumour of the anterior mediastinum Associated with:
Causes of death:
A 28-year-old man is investigated for cervical lymphadenopathy. A biopsy shows nodular sclerosing Hodgkin's lymphoma.
Which one of the following factors is associated with a poor prognosis?
Correct Answer D: Night sweats are a 'B' symptom and imply a poor prognosis.
Hodgkin's lymphoma: histological classification and prognosis:
Hodgkin's lymphoma is a malignant proliferation of lymphocytes characterized by the presence of the Reed-Sternberg cell. It has a bimodal age distributions being most common in the third and seventh decades.
Histological classification:
Symptoms also imply a poor prognosis:
Other factors associated with a poor prognosis identified in a 1998 NEJM paper included:
A 24-year-old man is diagnosed with a deep vein thrombosis of his right leg. He is initially treated with low molecular weight heparin but is switched after three days to warfarin. He then develops necrotic skin lesions on his lower limbs and forearms.
Which one of the following conditions is characteristically associated with this complication?
Protein C deficiency:
Protein C deficiency is an autosomal codominant condition which causes an increased risk of thrombosis.
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