Mehdi Masoud 200910759

8/13/2019 Mehdi Masoud 200910759

1/13

Mehdi masoud 200910759ali mohammad 200810781

8/13/2019 Mehdi Masoud 200910759

2/13

Case:

50years old lady, seeking full denture, during

examination you noted a palpable, fixed, indurated

supraclavicular lymph node.

Her past medical history was heavy drinker andsmoker

8/13/2019 Mehdi Masoud 200910759

3/13

Supraclvicular node:

function:

The function of the supra clavicular lymph nodes and otherlymph nodes is to filter lymph fluid in the body. The right

supraclavicular lymph node is responsible for lymphatic drainage

of mediastinum, lungs, and esophagus. The left supraclavicular

lymph node is responsible for lymphatic drainage of the thorax

and abdomen.

8/13/2019 Mehdi Masoud 200910759

4/13

Causes of enlargement of supraclavicular L.N:

Bacterial infection

Fungal infection Lymphoma

Thoracic cancer

Retroperitoneal cancer

Effect of alcohol and somking:

Alcohol use clearly rasies the the risk of these cancers. Drinking andsmoking toghether raise the risk of these cancer than effect of eachone individually. This is because alcohol can act as solvent, helpingharmful chemicals in tobacco to get into the cell lining the digistivetract. Alcohol may also slow down these cells ability to repair DNA

damage caused by chemicals in tobacco

8/13/2019 Mehdi Masoud 200910759

5/13

Differntial diagnosis:

Lymphoma(hodgkin and non-hodgkin)

Metastas from lung cancer

Metastas from abdominal cancer (insetine, gastric)

8/13/2019 Mehdi Masoud 200910759

6/13

Lymphoma:Lymphoma is a type of blood cancer that occurs when B or

T lymphocytes divide faster than normal cells or live longer

than they are supposed to.

Hodgkin's lymphoma is one of the most well-known types

of lymphoma, is marked by the presence of a type of cell

called the Reed-Sternberg cell.

The non-Hodgkin lymphomas any kind of lymphomaexcept Hodgkin's lymphomas. They vary significantly in

their severity, from indolent to very aggressive.

8/13/2019 Mehdi Masoud 200910759

7/13

Investigation:

Past medical history

Physical and clinical examination

FBC:to exclude leukaemia, mononucleosis and other

causes of lymphadenopathy

ESR: an ESR of greater than 70 carries an unfavourableprognosis

CT scans of the thorax and abdomen are required for

staging Hodgkin's lymphoma.

Lymph node biopsy: to provide sufficiently large specimenfor fresh frozen and formalin-fixed samples.

Bone marrow biopsy is indicated for staging purposes

8/13/2019 Mehdi Masoud 200910759

8/13

Gallium scans

Liver function and serum protein tests

Fine needle aspiration: a diagnostic procedure used toinvestigate superficial lumps or masses

8/13/2019 Mehdi Masoud 200910759

9/13

Treatment:

Chemotherapy

Radiation

Stem cell transplant Surgery

combination

8/13/2019 Mehdi Masoud 200910759

10/13

Prognosis:new types of chemotherapy increased the survival rate than pervious.

5 years survival is seen in 98% of patients with favorable prognosis.

The adverse prognostic factors:

Age 45 years

Stage IV disease

Hemoglobin < 10.5 g/dl Lymphocyte count < 600/l or < 8%

Male

Albumin < 4.0 g/dl

White blood count 15,000/l

8/13/2019 Mehdi Masoud 200910759

11/13

Oral Complication of chemotherapy and

radiotherapy

Mucositis

Infection

taste change

dry mouth

Pain

Dehydration

Malnutrition tooth decay and gum disease

8/13/2019 Mehdi Masoud 200910759

12/13

Preventive mesaure:

Balanced diet Good oral hygiene

Prevent invasive dental procedure

Oral health examination by dentist

8/13/2019 Mehdi Masoud 200910759

13/13