Lymphoma (especially high grade lymphoma) is very responsive to steroids - for this reason, in any patient with suspected lymphoma, avoid steroids where possible as this reduces sensitivity of PET-CT scans and can practically 'melt' away lymphoma tissue..

..this significantly reduces the chance of a diagnostic biopsy, and lymphoma is a biopsy-proven condition, imaging alone is not enough. If in doubt (as this issue can pose challenges-see below) speak to haematology. 4 possible scenarios below

Case; Pt. presented with lymphadenopathy and large abdo mass encasing ureters.
Scenario 1; Renal function not affected at presentation. Biopsy performed. Result awaited to ensure biopsy sample diagnostic. Biopsy result returns as lymphoma, and steroids/chemo can then be given.

Scenario 2; Renal function not affected at presentation. Biopsy performed. Renal function starts to deteriorate before biopsy result returns, and steroids are given to protect renal function. Biopsy may be diagnostic/non-diagnostic, needing further biopsy, but renal func priority

Scenario 3; Patients presents with renal impairment requiring dialysis. Steroids are given immediately to protect renal function as much as possible, and biopsy is organised for next 1-2 days. Chance of non-diagnostic specimen increased, but renal function critical

Scenario 4; Patient received a course of steroids from another clinician to see if this improves lymphadenopathy. This shrinks nodes, and tissue biopsies are repeatedly non-diagnostic. This prevents effective treatment as lymphoma needs different chemo according to subtypes

So biopsy must be successful to diagnose lymphoma and steroids should be avoided whenever possible, but there are cases in which steroids need to be given when there is a threat to organ/life. Discuss with haematology if unsure. #blooducation