Laboratory Workup for Growing Mass in Elderly Patient
For an elderly patient with an enlarging palpable mass, order a complete blood count, comprehensive metabolic panel (including liver function tests with ALT, AST, bilirubin, alkaline phosphatase, and albumin), lactate dehydrogenase (LDH), and beta-2 microglobulin to evaluate for malignancy, particularly lymphoma. 1
Initial Laboratory Panel
Essential Tests for Mass Evaluation
Complete blood count (CBC): Essential to detect hematologic abnormalities that may indicate lymphoma or other malignancies 1
Comprehensive metabolic panel: Including liver biochemical tests (ALT, AST, bilirubin, alkaline phosphatase, GGT) to assess organ function and detect metabolic derangements 1, 2, 3
LDH and beta-2 microglobulin: Critical tumor markers for lymphoma risk stratification, particularly in elderly patients where lymphoma is common (median age 61 years) 1
Uric acid: Recommended for lymphoma workup to assess tumor burden 1
Infectious Disease Screening
- HIV, Hepatitis B and C screening: Recommended in elderly patients with suspected lymphoma or other malignancies 1
Age-Specific Laboratory Considerations
Expected Age-Related Changes (Not Pathologic)
Alkaline phosphatase: May be elevated up to 2.5 times normal in healthy elderly 4, 5
ESR: Can be elevated up to 40 mm/hr without disease 4
Albumin decline: Associated with increased mortality risk and should prompt concern 3
Creatinine: May appear normal despite significantly reduced creatinine clearance due to decreased muscle mass 4, 5
Critical Pitfall
Do not dismiss abnormal liver function tests or declining albumin as "normal aging"—these findings in the context of a growing mass warrant aggressive workup. 3 While some laboratory values shift with age, a significantly abnormal result should raise suspicion of underlying disease rather than being attributed to aging alone. 5
Imaging Should Precede or Accompany Labs
Ultrasound: Should be performed for initial mass characterization 1
CT scan: May be necessary depending on mass location (neck, thorax, abdomen, pelvis for suspected lymphoma) 1
Tissue Diagnosis Priority
Laboratory tests alone cannot diagnose the etiology of a growing mass—tissue biopsy (excisional lymph node biopsy or core biopsy) is essential for definitive diagnosis and should not be delayed. 1 Fine-needle aspiration should be avoided as it is insufficient for appropriate diagnosis, particularly for lymphoma. 1
The laboratory workup serves to assess fitness for intervention, detect complications, and provide prognostic information, but the growing nature of the mass mandates tissue diagnosis regardless of laboratory results. 1