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| {{CMG}}; {{AE}} {{Preeti}} | | {{CMG}}; {{AE}} {{Preeti}} |
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| {| class="wikitable"
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| ! colspan="3" rowspan="2" |
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| ! rowspan="2" |Pathophysiology
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| ! rowspan="2" |Symptoms
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| ! colspan="3" |Laboratory Findings
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| |-
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| !Immunochemistry
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| !Blood work
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| !Biospy/CT/CXR
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| |-
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| | rowspan="9" |'''Infections'''
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| | rowspan="3" |'''Bacterial'''
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| | rowspan="2" |'''Syphilis'''
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| | rowspan="2" |
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| * Syphilis is caused by a [[spirochete]], [[Treponema pallidum|''Treponema pallidum'']].
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| * It has an average incubation period of 3 - 12 weeks.
| | ==References== |
| * Spirochete penetrates intact mucous membrane or microscopic dermal abrasions and rapidly enters systemic circulation with the [[central nervous system]] being invaded during the early phase of infection.
| | {{Reflist|2}} |
| * The histopathological hallmark findings are endarteritis and plasma cell-rich infiltrates reflecting a delayed-type of hypersensitivity reaction to the spirochete.
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| | rowspan="2" |
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| '''Primary syphilis'''
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| * Mononuclear leukocytic infiltration, [[macrophages]], and [[lymphocytes]]
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| * Swelling and proliferation of small blood vessels
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| '''Secondary syphilis'''
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| * Swelling and dilatation of blood vessels in the [[dermis]]
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| * Epidermal [[hyperplasia]] and neutrophilic infiltration
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| * Inflammatory cell infiltrate, predominantly [[plasma cell]]
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| '''Tertiary syphilis'''
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| * Small vessel inflammation ([[endarteritis obliterans]])
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| * Granulomatous lesions ([[gumma]]) containing central necrosis, inflammatory cells, such as [[lymphocytes]], [[macrophages]], [[plasma cells]] and [[Fibroblast|fibroblasts]].
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| | rowspan="2" |
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| *
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| * A presumptive diagnosis of syphilis is possible with the use of two types of serologic tests.
| | {{WH}} |
| :* Nontreponemal tests (e.g., [[VDRL|venereal disease research laboratory (VDRL)]] and [[RPR|rapid plasma reagent test]]) and
| | {{WS}} |
| :* Treponemal tests (e.g., [[FTA-ABS|fluorescent treponemal antibody absorbed (FTA-ABS) tests]], the ''T. pallidum'' passive particle agglutination (TP-PA) assay, various [[Enzyme linked immunosorbent assay (ELISA)|enzyme immunoassays]], and [[Chemiluminescence|chemiluminescence immunoassays]]). | | [[Category: (name of the system)]] |
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| | rowspan="2" |Darkfield examinations and tests to detect ''[[T. pallidum]].''
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| |'''Brucellosis'''
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| |[[humans]] could be infected by eating undercook meat or raw [[Dairy product|dairy]] products, inhalation of the [[bacteria]] and direct contact of bacteria with [[skin]] [[wounds]] or [[Mucous membranes|mucous membranes.]] Following transmission, [[white blood cells]] phagocyte the pathogen and transports it via hematologic or [[Lymphatic system|lymphatic route]] to different organs specially to those of the [[reticuloendothelial system]].
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| * Fever
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| * Rash
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| * Abdominal pain
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| * weightloss
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| * Painful lymphadenopathy
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| * hepatosplenomegaly
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| * arthritis
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| * [[Lymphocytosis|Relative lymphocytosis]]
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| * positive titer of anti-[[Brucella|b''rucella'']] [[antibodies]] on serological testing
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| * There are two types of serological tests, based on:
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| ** Antibody production against [[lipopolysaccharide]]
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| ** Antibody production against other [[bacterial]] [[antigens]]
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| * [[Brucella|''Brucella'']] is most commonly isolated from blood cultures (blood cultures are positive between the 7th and 21st day)
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| | rowspan="4" |'''Viral'''
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| |'''infectious mononucleosis'''
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| * Epstein-Barr virus, frequently referred to as [[EBV]],
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| * the [[EBV|virus]] infects [[B cells]] located in the oropharyngeal epithelium and subsequently spreads to involve the [[lymph nodes]], [[liver]] and [[spleen]].
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| * incubation period ranges from 4 to 6 weeks.
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| *
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| |Characteristic triad of [[fever]], [[pharyngitis]], and [[lymphadenopathy]] lasting for 1 to 4 weeks.
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| Common [[symptoms]] include low-grade [[fever]] without [[chills]], [[sore throat]], white patches on [[tonsils]] and back of the throat, [[muscle weakness]] and sometime extreme [[fatigue]], tender [[lymphadenopathy]], [[petechial hemorrhage]] and [[skin rash]].
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| * presence of [[Lymphocytes|atypical lymphocytes]] (often recorded by automated blood analyser machines as an increase in the monocycte count) is characteristic of [[EBV|EBV infection]].
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| *
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| ==== Peripheral Blood Smear ====
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| * hallmark of the disease is the presence of [[Reactive lymphocyte|atypical lymphocytes]] (a type of mononuclear cell) .
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| * [[Lymphocytosis|Atypical lymphocytosis]] is present in approximately 75% of patients
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| * Greater than 10% atypical lymphocytes is diagnostic of mononucleosis.
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| |'''cytomegalovirus'''
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| * Presents with [[encephalitis]], [[retinitis]], progressive [[myelitis]] or [[polyradiculitis]].
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| * In disseminated disease, it involves both [[liver]] and renal organs.
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| |Common [[symptoms]] include [[sore throat]], swollen [[lymph nodes]], [[fever]], [[headache]], [[fatigue]], [[weakness]], [[muscle pain]] and [[loss of appetite]].
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| * Abdominal examination reveals [[splenomegaly]].
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| * [[Maculopapular rash]] may be present.
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| * Positive monospot test.
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| * Elevated [[liver enzymes]]
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| * [[PCR]] of CSF with detectable virus is diagnostic.
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| * CT/MRI/biopsy: location of lesions are usually near the [[brain stem]] or periventricular areas.
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| * Brain biopsy with + staining for [[CMV]] or evidence of owl's eyes is also diagnostic.
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| |'''human immunodeficiency virus'''
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| |Acute HIV infection may be asymptomatic or may cause a [[mononucleosis]]-like syndrome
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| |[[fever]], [[fatigue]], [[sore throat]], [[myalgia]], and [[lymphadenopathy]]
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| |'''cat scratch fever'''
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| |The causative organism was first thought to be ''Afipia felis'', but this was disproved by immunological studies demonstrating that cat scratch fever patients developed antibodies to two other organisms, ''[[Bartonella henselae]]'' (''B. henselae'') and ''Bartonella clarridgeiae'', which are rod-shaped [[Gram-negative]] bacteria.
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| |'''Mycobacterial'''
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| |'''tuberculosis'''
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| * Mostly in endemic areas
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| |Symptoms include [[productive cough]],[[night sweats]], [[fever]] and [[weight loss]], [[hemoptysis]]
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| * [[Sputum]] smear positive for [[acid-fast bacilli]]<nowiki/>and nucleic acid amplification tests (NAAT) is used on sputum or any sterile fluid for rapid diagnosis and is positive for mycobacteria.
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| |Mild normocytic [[anemia]], [[hyponatremia]], and
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| [[hypercalcemia]]
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| * CXR and CT demonstrates [[Internal|cavities]] in the upper lobe of the lung
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| |'''Parasitic'''
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| |'''toxoplasmosis'''
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| |A [[parasitic disease]] caused by ingestion of cat feces, affect all organs and particularly dangerous in [[pregnant]] woman. Toxoplasma infections may also present with a mononucleosis-like syndrome seen in patients with acute HIV syndrome.
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| | rowspan="4" |'''Autoimmune'''
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| | colspan="2" |'''Systemic lupus erythematosus'''
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| |skin [[rash]], [[arthritis]], positive [[autoimmune]] serology, [[weight loss]], [[Fever|fevers]]<nowiki/>and [[chronic pain]],
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| |[[ESR]] and [[CRP]]<nowiki/>elevated, positive [[ANA]]
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| | colspan="2" |'''Sjögren's syndrome'''
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| |skin [[rash]], [[arthritis]], positive [[autoimmune]] serology, [[weight loss]], [[Fever|fevers]]<nowiki/>and [[chronic pain]],
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| | colspan="2" |'''Hydantoin derivatives'''
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| | colspan="2" |'''Sarcoidosis'''
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| * More common in African-American females
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| * Often [[asymptomatic]] except for [[Lymphadenopathy|enlarged lymph nodes]]
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| * Associated with [[restrictive lung disease]]
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| * [[Erythema nodosum]]
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| * [[Lupus pernio]] (skin lesions on face resembling lupus)
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| * [[Bell's palsy|Bell palsy]]
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| * [[Epithelioid]] [[granuloma]]<nowiki/>s containing microscopic [[Schaumann bodies|Schaumann]] and asteroid bodies
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| * On CXR bilateral [[Lymphadenopathy|adenopathy]] and coarse reticular opacities are seen.
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| * CT of the chest demonstrates extensive [[Hilar lymphadenopathy|hilar]] and mediastinal adenopathy
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| * Additional findings on CT include [[fibrosis]] (honeycomb, linear, or associated with bronchial distortion), pleural thickening, and ground-glass opacities.
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| * Biopsy of lung shows non-[[caseating]][[granuloma]]
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| | rowspan="6" |'''Neoplasms'''
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| | colspan="2" rowspan="1" |'''Hodgkin's disease'''
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| |Reed-Sternberg cell
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| * B-cell origin
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| * CD30 (Ki-1) and CD15 (Leu-M1) antigens
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| * Painless localized peripheral lymphadenopathy
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| * B symptoms
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| * Lactate dehydrogenase (LDH) may be increased.
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| * ESR elevated
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| * Serum creatinine elevated in nephrotic syndrome.
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| * Alkaline phosphatase (ALP) increased
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| * Hypercalcemia, hypernatremia, and hypoglycemia.
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| *
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| Fine-needle aspiration
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| * Mononucleate and binucleate Reed-Sternberg cells in a background of inflammatory cells
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| | colspan="2" rowspan="1" |'''Chronic lymphocytic leukemia'''
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| * Clonal B cells arrested in the B-cell differentiation pathway,.
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| * [[Genetic mutation|Genetic mutations]] that promote both [[malignant]]<nowiki/>leukemic proliferation and [[apoptotic]] resistance of mature B cells.
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| * Structural [[Genetic mutation|genetic mutations]] involved in the pathogenesis of chronic lymphocytic leukemia include [[chromosome]] 13q deletion, chromosome 17p deletion, and chromosome 11q deletion.
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| * [[Fever]]
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| * Recurrent [[bleeding]]
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| * [[Weight loss]]
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| * [[Muscle wasting]]
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| * Generalized [[weakness]]
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| * Anorexia
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| * [[Night sweats]]
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| * [[Abdominal pain]]
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| * Recurrent [[Infection|infections]]
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| * Monoclonality of kappa and lambda producing [[B cell|B cells]]
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| * Presence of smudge cells
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| * Express [[CD19]], [[CD20]], [[CD23]], and [[CD5]] on the [[cell]] surface
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| |CBC
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| * Absolute [[lymphocytosis]] (>5000 cells/μl)
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| * Decreased [[hemoglobin]] concentration
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| * Decreased [[Platelet|platelets]] count
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| | colspan="2" rowspan="1" |'''Small cell carcinoma of the lung'''
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| * aggressive form of [[lung cancer]] and has the highest association with [[smoking]].
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| * starts in the [[bronchi]] and expands through the [[bronchial]] [[mucosa]] and [[Metastasize|metastasizes]] rapidly.
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| * A [[mutation]] in the [[p53]] [[gene]] is reported in 75%-100% of the cases.
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| |relatively rapid onset of symptoms and is associated with the occurrence of [[Paraneoplastic syndrome|paraneoplastic syndromes]] such as the [[syndrome of inappropriate antidiuresis]] ([[SIADH]]), hypercalcemia and many more.
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| * [[Cough]] (most common symptom)
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| * [[Wheezing]]
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| * [[Dyspnea]]
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| * [[Hemoptysis]]
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| * [[Chest pain]]
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| |Nearly all SCLC are immunoreactive for
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| * [[keratin]],
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| * [[thyroid transcription factor 1]],
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| * [[Epithelial cells|epithelial]] membrane [[antigen]]
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| [[Neuroendocrine]] and [[neural]] [[differentiation]] result in the expression of molecules like
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| * [[Dopamine beta-hydroxylase|dopa-decarboxylase]],
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| * [[calcitonin]]
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| * [[neuron-specific enolase]],
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| * [[chromogranin A]],
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| * [[CD56]]
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| * [[gastrin]]-releasing [[peptide]]
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| * [[insulin-like growth factor 1]]
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| |The confirmation of the diagnosis of SCLC is by tumor [[biopsy]].
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| patients with confirmed diagnosis of SCLC should undergo a [[CT scan]] of the [[abdomen]] for staging purposes.
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| [[Computed tomography|CT scan]] of the [[abdomen]] helps identify [[metastasis]] to organs, such as the [[liver]] or the [[adrenal glands]].
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| | colspan="2" rowspan="1" |'''Malignant histiocytosis'''
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| | colspan="2" rowspan="1" |'''Melanoma'''
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| * melanoma is the result of multiple genetic mutations. The progression to melanoma usually involves the serine-threonine kinases of the [[MAPK/ERK pathway]] (mitogen-activated protein kinase) following mutation of either the ''[[Ras|N-RAS]]'' or ''[[BRAF]]'' oncogene
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| * changes include the overexpression of [[Cadherin|N-cadherin]], [[Integrin|αVβ3 integrin]], MMP-2, [[MSH]], [[cAMP]], and [[survivin]], and the loss of [[E-cadherin]] and TRMP1 proteins
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| |Symptoms of melanoma include the following:
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| * Rapid growth of an existing [[nevus]]
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| * [[Nevus|Bleeding nevus]]
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| * [[Nodule|Cutaneous nodules]]
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| * [[Hyperpigmentation|Hyper]]/[[Hypopigmented area|hypopigmented skin lesion]]
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| * [[Lymphadenopathy|Lymphatic masses]]
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| * [[Melanonychia]] (brown/blue nail discoloration)
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| * [[Skin ulcer|Non-healing skin ulcer]]
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| * [[Skin lesion|Painful skin lesion]]
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| * [[Pruritus]]
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| * [[Bone pain]]
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| |An excisional biopsy (either elliptical, punch, or saucerization) of the thickest portion of the lesion with 1-3 mm margins is diagnostic.
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| | colspan="2" rowspan="1" |'''Germ cell neoplasms'''
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| | rowspan="5" |'''Other conditions'''
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| | colspan="2" rowspan="1" |'''Reactive lymphoid hyperplasia'''
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| | colspan="2" rowspan="1" |'''[[Lymphomatoid granulomatosis]]'''
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| |Lymphamatoid granulomatosis manifests in a variety of clinical forms.
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| * [[Cough]]
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| * [[Dyspnea]]
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| * [[Chest pain|Chest tightness]]
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| * [[Malaise]]
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| * [[Weight loss]]
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| * [[Fatigue]]
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| * [[Fever]]
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| * [[Headache|Headaches]]
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| * [[Seizure|Seizures]]
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| * [[Hemiparesis]]
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| * [[Ataxia]]
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| * [[Rash|Erythematous rash]]
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| * [[Macule|Macules]]
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| * [[Papule|Papules]]
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| * [[Plaque|Plaques]]
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| * [[Nodule (medicine)|Subcutaneous nodules]]
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| * [[Nodule (medicine)|Larger ulcerated nodules]]
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| |'''CBC'''
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| * [[Leukopenia]]
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| * [[Lymphocytopenia|Lymphopenia]]
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| * Low [[CD4]] count
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| * [[Leukocytosis]] is rare
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| * Elevated [[Hematocrit]]
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| |The following x-ray findings are suggestive of assisting in diagnosing Lymphmotoid granulomatosis:
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| * [[Nodules|Bilateral nodules]] or [[Mass|masses]] in the lower and peripheral lung
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| * [[Infiltration (medical)|Pulmonary infiltrates]]
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| * [[Pleural effusion]] in some cases
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| * [[Cavitation]] of nodules
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| * Chest CT scan may be helpful in the diagnosis of Lymphomatoid granulomatosis. Findings on CT scan suggestive of/diagnostic of Lymphomatoid granulomatosis include:
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| *** [[Nodule (medicine)|Nodules]]
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| *** [[Cavitation|Cavitations]]
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| *** [[Mass|Masses]]
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| *** [[Halo sign]] is seen due to the angioinvasive nature of the disease
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| ***
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| | colspan="2" rowspan="1" |'''Dermatopathic lymphadenopathy'''
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| | colspan="2" rowspan="1" |'''Angioimmunoblastic lymphadenopathy'''
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| * Clonal [[T-cell receptor]] and [[immunoglobulin]] gene rearrangements
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| * [[Epstein–Barr virus]] (EBV) has been found in both reactive B-cells and the neoplastic T-cells.
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| * [[Trisomy]] 3, trisomy 5, and +X are the most frequent chromosomal abnormalities found in cases..
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| * Characteristic findings on gross pathology, aborization and proliferation of [[high endothelial venules]]
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| * On microscopic histopathological analysis, [[CD4]]+ [[T-cells]], [[CD8]]+ [[T-cells]], and polyclonal [[plasma cells]].
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| |Symptoms include:
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| * [[Fever]]
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| * [[Weight loss]]
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| * [[Skin rash]]
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| * [[Night sweats]]
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| * [[Edema]]
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| * Chest pain
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| * [[Abdominal pain]]
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| * [[Bone pain]]
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| * Painless swelling in the neck, axilla, groin, thorax, and abdomen
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| * [[Fatigue]]
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| * [[Pale skin color]]
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| * [[Dark urine]]
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| * [[Chronic pain]] and swelling of the joints
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| * Immunophenotyping
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| :* Positivity for [[CD2]], [[CD3]], [[CD4]], [[CD5]], [[CD10]], [[CD20]], and focal positivity for [[CXCL13]]
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| :* Negative for ALK1 and [[CD30]]
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| * Fluorescence in situ hybridization ([[FISH]])
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| :
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| * [[Complete blood count]] (CBC)
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| :* [[Anemia]]
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| :* [[Eosinophilia]]
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| |Lymph node or extranodal tissue biopsy is diagnostic of angioimmunoblastic T-cell lymphoma.
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| CT scan suggestive of angioimmunoblastic T-cell lymphoma include:
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| * [[Lymphadenopathy|Mediastinal lymphadenopathy]]
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| * [[Lymphadenopathy|Inguinal lymphadenopathy]]
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| * [[Lymphadenopathy|Aortal lymphadenopathy]]
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| * Bilaterally enlarged kidneys
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| | colspan="2" rowspan="1" |'''Giant lymph node hyperplasia (Castleman disease)'''
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| |Castleman's disease is likely due to hypersecretion of the cytokine [[Interleukin 6|IL-6]]. In KSHV positive tumors, this is most likely due to expression of the a virus-encoded cytokine, vIL-6, while KSHV negative tumors appear to be the result of over secretion of human IL-6.
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| |The most common '[[B symptoms]]' of MCD are
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| * High [[fevers]]
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| * [[Anemia]]
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| * [[Weight loss]]
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| * [[Loss of appetite]]
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| Other symptoms include:
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| * [[Cough]]
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| * Chest discomfort
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| * [[Fatigue]]
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| * [[Weakness]]
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| * Complete blood count and differential count - [[low white blood cell counts]], which may to be due to the overproduction of [[interleukin 6]].
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| * [[Erythrocyte sedimentation rate]] - elevated in 80% cases.
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| |}
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