Pregnancy Care in Family Medicine: From A Painful Lymphadenopathy to A Rare Non-Hodgkin’s Lymphoma Case

A 32-year-old, 17-week pregnant patient visited her family physician because of painful lymphadenopathy on the right side of her neck after an upper respiratory tract infection. On physical examination, her vital signs were stable. A few elastic, firm, fixed, and painful lymphadenopathies, the largest of which was 1 cm were detected in the right cervical region, and the pharynx of the patient was hyperemic. Empirical antibiotherapy treatment was initiated by the family physician with the diagnosis of upper respiratory tract infection and the patient was called for control follow-up. Due to the rapid growth of lymph nodes and their size over 1 cm, she was referred to the otorhinolaryngology outpatient clinic with a preliminary diagnosis of malignancy. She was diagnosed with Diffuse Large B Cell Lymphoma. Pregnancy termination was recommended to the patient whose chemotherapy was scheduled, but the patient refused. At the 32nd week of pregnancy, the pregnancy was terminated due to fetal distress and a 1500-gram live baby girl was born. Since it is associated with pregnancy and rare, and that the family physician plays a role in early diagnosis of a important disease such as malignancy, it is deemed appropriate to present the case with literature.

Aile Hekimliðinde Gebelik Ýzlemleri: Aðrýlý Lenfadenopatiden Nadir Hodgkin Dýþý Lenfoma Olgusuna

32 yaþýnda, 17 haftalýk gebe hasta, üst solunum yolu enfeksiyonu sonrasýnda boynunun sað tarafýnda aðrýlý bir kitle fark edip aile hekimliði polikliniðine baþvurdu. Fizik muayenede vitalleri stabildi. Farinksinin hiperemik olduðu, sað servikal bölgede en büyüðü 1 cm olan birkaç adet lastik kývamýnda, sert, fikse, aðrýlý lenfadenopatisi olduðu saptandý. Hastaya aile hekimi tarafýndan üst solunum yolu enfeksiyonu tanýsý ile ampirik antibioterapi baþlanýp kontrole çaðrýldý. Lenf bezlerindeki hýzlý büyüme ve boyutlarýnýn 1 cm’in üzerinde olmasý nedeni ile malignite ön tanýsý ile kulak burun boðaz polikliniðine sevk edildi. Alýnan eksizyonel biyopsi sonucunda Diffüz Büyük B Hücreli Lenfoma tanýsý aldý. Kemoterapi planlanan hastaya gebelik terminasyonu önerildi ancak hasta reddetti. Gebeliðin 32. haftasýnda fetal distres nedeni ile 1500 gr kýz bebeðin sezaryen ile canlý olarak doðumu gerçekleþtirildi. Gebelikle baðlantýlý olmasý ve seyrek görülmesi, malignite gibi hayati bir hastalýkta aile hekiminin erken teþhiste rol almasý nedeniyle olgunun literatür eþliðinde sunulmasý uygun görülmüþtür.