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Forum Name: Lymphoma

Question: Enlarged submandibular lymph node!!


 hasan - Mon Dec 18, 2006 5:17 pm

My father aged 59 had submandibular swelling on the right side and had it removed surgically 2 weeks ago..the mass was about 7cm and it did not cause any kinda pain or difficulty while eating or drinking but since it grew bigger my father thought to have it removed.now the lab reports came and it said
" LYMPHOCYTES PRESENT , FOCI OF NECROSIS WITHOUT FIBROSIS" AND UNDER DIAGNOSIS "DIFFUSE MALIGNANT LYMPHOMA WAS WRITTEN WITH DIFFERENTIALS OF DIFFUSE LARGE CELL LYMPHOMA ..
i'm concerned as to what is the general prognosis of the treatment since it was isolated ??second thing that bothers me necoris without fibrosis??what does it actually mean ,,which one is worse??wud there be any side effects of treatment like hair loss and will it be permanent ??the other thing well -differentiated is good or poor differentiated???
please I'd highly appreciate your reply back asap at baber76@yahoo.com..Thank you
 Dr. Tamer Fouad - Tue Dec 19, 2006 9:19 am

User avatar Hello,

There are two types of Non-Hodgkin's lymphoma (NHL) as regards outcome: 1. Aggressive where the disease course progresses more rapidly (months) and are more responsive to curative therapy. 2. Inodlent NHL where the time course is prolonged (years) and are paradoxically less responsive to curative therapy.

Diffuse large cell Non-Hodgkin's lymphoma is an aggressive type of lymphoma which means it belongs to the group that responds better to treatment.

His overall prognosis will depend on many factors which include the stage of his disease as judged by investigations (CT scan, bone marrow biopsy, LDH, etc). His age, any co-morbid conditions and his performance status (a measure of his physical activity). The age limit here is 60 years, so it could be tricky since he is 59 years old. A general evaluation of his physical activity and general health will play a role in deciding how he should be cagegorized.

Toxicity depends what therapy he will receive. The gold standard is CHOP vs. CHOP-Rituximab in those with CD20+ B-cell NHL. Radiotherapy is an option in early cases. Alternative regimens may be tailored according to the patient's condition.

CHOP chemotherapy does lead to loss of hair.

Please have a more in-depth look at NHL on our website at this page: nhl.htm" class="postlink">Click here!

Best regards,
 hasan - Tue Dec 19, 2006 2:28 pm

I do appreciate ur reply.thank you but again which is worse necrosis or fibrosis??i mean what's the difference between 2?i'd highly regard your response..does necrosis whenever it occurs mean cancer and ssame goes for fibrosis??do they mean initial stages of cancer of any form?
 hasan - Tue Dec 19, 2006 2:29 pm

i do appreciate ur reply.thank you but again which is worse necrosis or fibrosis??i mean what's the difference between 2?i'd highly regard your response..does necrosis whenever it occurs mean cancer and same goes for fibrosis??do they mean initial stages of cancer of any form?
 Dr. Safaa Mahmoud - Thu Dec 21, 2006 2:07 pm

User avatar Hello,

It would be more helpful if you can inform us about the detailed pathological study of the lymph node,(the full report) and if any other studies have been done on the slide (immunophenotyping if it was not totally necrotic) or any other blood tests or radiological assessment for systemic disease.

According to your description it sounds like an infracted lymph node (lymph node infaction or necrosis). A relatively uncommon condition. Although it does not mean malignancy it has been reported to precede, or occur simultaneously with, malignant lymphoma.

The pathological diagnosis of necrotic lymph node is very confusing for pathologist as to relate it to infectious, traumatic causes, or to malignancy.

Of importance in these patients who could not be proved to be of malignant disease, is either close follow up, or to do another biopsy from a relevant suspicious lymph node.

Hope this information is useful.

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