Case Study 9

Disorders of White Blood Cells and Lymphoid Tissues

Max is a 60-year-old living in Iowa. For the 27 years, he has been working in the agricultural industry, particularly in the management of corn production. Recently he began to feel weak during work and tired easily. During the night he woke up sweating, and he often felt unusually warm during the day. Max was also surprised that, in spite of eating regularly, his weight was declining and his work pants were now too large for him. Upon physical examination, his physician noted his inguinal lymph nodes were swollen although Max said they were not sore. Subsequent laboratory tests confirmed follicular, non-Hodgkin lymphoma. Chemotherapy in conjunction with rituximab was immediately initiated.

1. What are the key cellular differences between non-Hodgkin lymphoma and Hodgkin lymphoma?
2. The early manifestations of non-Hodgkin lymphoma and Hodgkin lymphoma in lymphatic tissue appear differently. In terms of lymphatic presentation, how would these two diseases appear clinically?
3. What are the pharmacologic properties of rituximab, and what is its mechanism of action on malignant cells?
4. Outline the structure of lymph node parenchyma including the areas where B and T lymphocytes reside. Where did Max’s lymphoma arise?

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