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Forum Name: Lymphoma

Question: Confusing biopsy results ...


 jots_in_nj - Thu Apr 19, 2007 9:53 pm

Hello! I had a surgical biospy for suspected lymphoma and the results are somewhat confusing. My Doc told me "don't owrry, you're fine," but he couldnt really explain what the results emant. Hopefully I am summarizing the "important" parts below!

Findings were:

- an expanded population (~11%) of immunophenotypically aberrant CD2+ CD5+ CD7+ T cells that are *double negative* CD4 - CD 8 - abd CD 3 -, but are "mature" (CD45(bright)+ TdT- CD1a-, CD34- and do not express CD16 CD 56 or CD 57.

- there is eveidence of polyclonia rearrangement only, without any evidence of a dominant clone

- the significane of this abnormal t-cell expansion is uncertain and it reamins enigmatic. While it may represent a reactive proliferation of atypical NK/T cells, the cells appartnly lack significant expression of cd16, cd56 cd 57.

- Although the lack of cd3 cd4 and cd8 may suggest a presursor t-cell expansion, the bright cd45 and lack of cd1a cd10 cd34 tdt expession mitigate against this consideration.

Should I seek a second opinion on the biopsy material? The end result seems very "conditional," with many "odd things" in the biospy.

My bone marrow biopsy showed "mildly hypercellular bone marrow with trilineage hematopoiesis.

Prior symptoms were a single swollen node for 9 months, followed by an overnight swelling of two more nodes, fever for 16 days, bone pain, fatige, and 12 pound weight loss. It's been two months since the biopsy and I still have the swollen nodes and the bone pain, but the fever has resolved.

Thank you for any suggestions ... I am terrified that they are missing something or that I need to pursue this further.

Michelle
 Dr. Chan Lowe - Fri Apr 27, 2007 9:04 pm

User avatar I suspect that most of your findings are consistent with an immune reaction to a viral infection, especially given that you had new nodes that appeared "overnight".

I would recommend that you discuss your biopsy results with a hematologist/oncologist. The heme/onc specialist will have the expertise necessary to properly interpret these results.

From what I can tell, they did not see anything definitive of lymphoma but there was evidence of a "ramped up" bone marrow which may be due to your recent illness. The thing that makes me a little suspicious is that the fever lasting 16 days is unusual for a viral infection. Also, they generally do not cause weight loss.

Follow up with your doctor is very important becuase your symptoms are not typical of a common cold and your biopsy does have some atypical cells in it (though not overtly cancerous).

Please keep in mind that my knowledge in this area is quite limited so none of what I am saying should be considered expert opinion.

Best wishes.
 jots_in_nj - Sat Apr 28, 2007 8:16 pm

Dr. Lowe,

Thank you very much for your post ... it is comforting to hear someone else agree, even if it's not an area of experteise.

I have since seen an infectious disease doc and he is running further tests. The biggest concern now is that the nodes are still enlarged, though the rest of the symptoms have gone away.

Is it possible that nodes can stay permanently significantly enlarged after an infection?

Thank you!
Michelle
 Dr. Chan Lowe - Sun Apr 29, 2007 6:44 pm

User avatar After an infection, lymph nodes may not fully reduce back down to size. They can often remain about a centimeter or so in size and are referred to as shotty lymph nodes.

Typically, lymph nodes will not remain significantly larger than this unless there is still activity within the lymph node (still fighting infection, etc.).

Best wishes. I hope you are able to find some answers soon.

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