Second opinion on biopsy?

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jots_in_nj
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Joined: Mon Dec 18, 2006 7:33 pm

Second opinion on biopsy?

Postby jots_in_nj » Tue Feb 13, 2007 12:02 pm

Hello ... I'm a healthy 30 year old female, I've had a swollen lymph node for 10 months, then a second node swelled up overnight in Jan. I also ran a fever of above 100 degrees for 16 days and started having night sweats (I've posted on here before).

Saw an ENT and oncologist, they did a fine needle biopsy which was inconclusive, then a general biopsy whcih showed negative for Hodgkins, still waiting for the non-Hodgkins results.

My LDH is now 1200 and my ESR is 45, liver functions are slightly elevated. Both have been increasing in the last month. All blood cultures are negative, and a round of antibiotics did nothing. PET/CT scan showed a slightly enlarged spleen and liver, three "active" nodes in my neck, and a small amount of uptake in my bone.

There were definetly abnormal lymphocites in the biopsy, and my oncologist was very surprised when the Hodgkins came back negative. He was sure that was what it was!

** Question1: ** Should I push for a second opinion on the biopsy? I'm at UPenn, and I am very confident in them, but I also understand it can be a tricky thing to do.

** Question 2: ** If non-Hodgkins comes back negative (keep your fingers crossed!) where do i go from there? Auto immune disorder? Infectious disease?

** Question3: ** Is it normal for a lymph node to swell substnatially after a biopsy is done? My ENT removed am "M&M sized piece" of the node, and 8 days later, the node is HUGE. Much larger than before.

My Docs agree "something" is wrong, they just can't put there finger on it. Who might be a good specialist to see next?

Thank you ...

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Dr. Safaa Mahmoud
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Posts: 1434
Joined: Sat Jan 04, 2003 7:53 am

Postby Dr. Safaa Mahmoud » Wed Feb 14, 2007 1:30 pm

Hello,

The history of your symptoms and the results of the blood test
" ESR" are very alarming and malignancy should be excluded first.

I think your doctor is waiting for the results of the immunophenotyping which is a pathological examination of certain markers expressed on the tissue.

Other causes like autoimmune diseases and infections should be searched (if malignancy is excluded) although your history is not strongly suggesting that.

I advise you to follow up with your doctor.
Keep us updated.
Best regards.
This answer does not substitute for direct medical consultation.

Dr. Safaa Mahmoud.
MB BCh, MSc Internal Medicine. MD Medical Oncology.
PhD Experimental Medicine and Biochemical Science.

jots_in_nj
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Posts: 8
Joined: Mon Dec 18, 2006 7:33 pm

Postby jots_in_nj » Sat Feb 17, 2007 7:27 pm

I received my surgical biopsy results yesterday, after 15 days:

-- There were "abnormal lympocites"
-- Negative for Hodgkins
-- Negative for non-Hodgkins
-- Negative for infections

I am thrilled, of course!!!! But still concerned about where to go next. According to my oncologist, "something is wrong," but he just can't; tell me what. You said above:

"Other causes like autoimmune diseases and infections should be searched (if malignancy is excluded) although your history is not strongly suggesting that."

My oncologist has said he has done all he can ... he reccomends moving on to a new Dr. But if my history does not suggest auto-immune or infection, where should I go next?

In the meantime, my fevers has gone away and the night sweats have stopped. But I have not yet regained the 14 pounds I lost.

Thank you for any suggestions ...


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