Question 177 · LEK · Lymphomas and other systemic tumors

A 16-year-old patient complaining of persistent pruritus for 3 months uses immunosuppressive treatment in the form of ointments and creams, prescribed by a dermatologist, with no result. In the patient's relation her neck has recently ‘swelled’, and she reports also weakness and reduced exercise tolerance. On the examination, tachypnea, a bundle of enlarged lymph nodes (the largest with a diameter of 3 cm) in the region of the sternocleidomastoid muscle and the supraclavicular area on the same side were noted. An increased vascularization of the chest skin is visible. The patient should be referred to:

1. AA. outpatient clinic to diagnose cholestasis that causes pruritus.
2. BB. center dealing with cancer treatment in children, because of the suspicion of superior vena cava syndrome secondary to lymphoma.
3. CC. oncological outpatient clinic to perform laboratory tests, ultrasound examination of cervical lymph nodes, virological tests and making appointment for biopsy.
4. DD. oncological surgery center with a recommendation for a core needle biopsy, because of the suspicion of Hodgkin's lymphoma.
5. EE. GP with a suggestion of diagnostic imaging: chest X-ray and ultrasound of the cervical lymph nodes.