Summary
Definition
History and exam
Key diagnostic factors
- hx of Helicobacter pylori gastritis
- hx of autoimmune disorder
- age >60 years
- dyspepsia
- epigastric discomfort
- skin lesions
- red eye ± photophobia
- painless proptosis, diplopia, motility disturbances of the eye, ptosis, decreased vision
Other diagnostic factors
- nausea and/or vomiting
- GI bleeding
- fever
- night sweats
- weight loss
- shortness of breath, hemoptysis, cough
- salivary gland swelling
- thyroid swelling
- breast lump
- focal neurologic deficits
- lymphadenopathy
Risk factors
- Helicobacter pylori infection
- age >60 years
- autoimmune diseases
- female gender
- Chlamydia psittaci infection
- Campylobacter jejuni infection
- Borrelia burgdorferi infection
- hepatitis C virus infection
- HIV infection
Diagnostic investigations
1st investigations to order
- CBC
- blood smear
- upper GI endoscopy
- biopsy of affected tissue
- H pylori serology
- H pylori stool antigen test
- LFTs
- basic metabolic panel
Investigations to consider
- bone marrow biopsy
- immunohistochemistry
- reverse transcriptase polymerase chain reaction (RT-PCR) or fluorescence in situ hybridization (FISH)
- immunoglubulin gene rearrangement studies
- serum electrophoresis
- serum LDH
- serum beta-2 microglobulin
- staging CT scan
- endoscopic ultrasound of the stomach
- double contrast radiograph of the GI tract
- lower GI endoscopy
- endoscopic otolaryngology
- CT scan of salivary glands
- MRI orbit
- hepatitis C serology
- hepatitis B serology
- HIV serology
- multiple-gated acquisition scan (MUGA)
- echocardiography
- ethylenediamine tetraacetic acid glomerular filtration rate (EDTA GFR)
Treatment algorithm
Contributors
Authors
Consultant Haematologist
Luton and Dunstable Hospital NHS Foundation Trust
Luton
UK
Disclosures
RJ declares that he has no competing interests.
Consultant Haematologist
Royal Free Hospital
London
UK
Disclosures
CM declares that he has no competing interests.
Peer reviewers
Professor of Medicine
Department of Internal Medicine I
Division of Oncology
Medical University Vienna
Austria
Disclosures
MR is an author of a number of references cited in this monograph.
Staff Hematologist
Cleveland Clinic Taussig Cancer Center
Cleveland
OH
Disclosures
AL declares that he has no competing interests.
Consultant Medical Oncologist
Royal Marsden Hospital
Sutton
UK
Disclosures
IC has been reimbursed by Roche Products, the manufacturer of rituximab, for attending several conferences. IC has also served on advisory boards and received honorarium for giving presentations for Roche Products. IC has received research funding from Novartis to conduct academic studies in the treatment of colorectal cancer.
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