Virchow's node, jaundice, and weight loss--lymphoma mimicking gastrointestinal malignancy.
BACKGROUND
A 46-year-old white male with a history of well-controlled paranoid schizophrenia presented with painless jaundice, progressive anorexia, weight loss, and dyspnea of 3 months' duration. His only medication at presentation was the antipsychotic olanzapine, taken orally.


METHODS
Physical examination and laboratory tests, including a complete blood cell count, electrolyte, lactate dehydrogenase and haptoglobin levels, liver function tests, and a Coombs' test; CT scan of the chest and abdomen; invasive investigations, including thoracentesis and pleural fluid analysis, bone-marrow biopsy, and left supraclavicular lymph-node biopsy.


METHODS
Diffuse large B-cell lymphoma.


RESULTS
Large-volume thoracentesis. Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone chemotherapy followed by dexamethasone, cytarabine, and cisplatin chemotherapy, and autologous stem-cell transplantation.
Anastassiades
Constantinos P
CP
Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. anastassiades.constantinos@mayo.edu
Poterucha
Thomas H
TH
D000855:Anorexia / Q000175:diagnosis* / Q000503:physiopathology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D019411:Clinical Laboratory Techniques; D003937:Diagnosis, Differential; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis*; D006801:Humans; D007565:Jaundice / Q000175:diagnosis*; D008206:Lymphatic Diseases / Q000175:diagnosis*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D019152:Paracentesis; D012563:Schizophrenia, Paranoid / Q000150:complications; D033581:Stem Cell Transplantation; D014057:Tomography, X-Ray Computed; D015431:Weight Loss