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Suggest Treatment For Enlarged Lymph Node On Neck Along With Weight Loss
Question: //Early Sept 14: Lump towards right side of the neck. Appeared to growing rapidly.
//Oct last'14 : Surgeon advised to undergo Blood, Urine, ESR, Regular needle FNAC Test. Except High ESR, rest of the results were negative.
//Oct last'14 : Visited TB specialist and undergone, Chest Xray, TB skin test, again needle FNAC. Except Skin test which was partial positive, everything else was negative. Referred for Biopsy.
//Oct last'14: Biopsy done. Outcome was inconclusive/Negative with no malignancy found & reactive lymphnoid hyperplasia.
// Early Nov'14: Started TB treatment on trial basis.
// XXXXXXX 15 : After continuing (AKT4) medicine for two months, no improvement is observed. Infact the size has grown by another 10%. LFT discovered liver toxity. Advised to stop AKT4. Went for another FNAC, result was inconclusive.
// Referred for Biopsy which took place last week. Report is attached.
Other symptom is weight loss. 5 kg has been lost over the period of 6 months. She delivered baby about 9 months back.
//Oct last'14 : Surgeon advised to undergo Blood, Urine, ESR, Regular needle FNAC Test. Except High ESR, rest of the results were negative.
//Oct last'14 : Visited TB specialist and undergone, Chest Xray, TB skin test, again needle FNAC. Except Skin test which was partial positive, everything else was negative. Referred for Biopsy.
//Oct last'14: Biopsy done. Outcome was inconclusive/Negative with no malignancy found & reactive lymphnoid hyperplasia.
// Early Nov'14: Started TB treatment on trial basis.
// XXXXXXX 15 : After continuing (AKT4) medicine for two months, no improvement is observed. Infact the size has grown by another 10%. LFT discovered liver toxity. Advised to stop AKT4. Went for another FNAC, result was inconclusive.
// Referred for Biopsy which took place last week. Report is attached.
Other symptom is weight loss. 5 kg has been lost over the period of 6 months. She delivered baby about 9 months back.
Brief Answer:
PET scan
Detailed Answer:
Hi
I have gone through your history and reports.
The right cervical lymph node biopsy does not show there is malignancy and it points towards infection.
Since there is history of weight loss and the size of the lump in neck is increasing in size even after tuberculosis treatment with AKT4 i would advise you to do a PET scan to find the exact cause of her enlarged lymph node in neck.
Regards
DR DE
PET scan
Detailed Answer:
Hi
I have gone through your history and reports.
The right cervical lymph node biopsy does not show there is malignancy and it points towards infection.
Since there is history of weight loss and the size of the lump in neck is increasing in size even after tuberculosis treatment with AKT4 i would advise you to do a PET scan to find the exact cause of her enlarged lymph node in neck.
Regards
DR DE
Above answer was peer-reviewed by :
Dr. Pradeep Vitta
Thanks for answering my query.
But Pathologist goes on saying further ''Features are of classical Hodgkin's Lymphoma. Immunohistochemical evaluation with a panel of markers is suggested to confirm the diagnosis''
I see above comments made by Pathologist in sharp contrast of your observation (infection) from the Biopsy report.
Please shed some more light and direct us towards right path.
But Pathologist goes on saying further ''Features are of classical Hodgkin's Lymphoma. Immunohistochemical evaluation with a panel of markers is suggested to confirm the diagnosis''
I see above comments made by Pathologist in sharp contrast of your observation (infection) from the Biopsy report.
Please shed some more light and direct us towards right path.
Brief Answer:
Immunohistochemical tests to be done
Detailed Answer:
Hi
I would also advise you to do a bone marrow biopsy test.
If XXXXXXX sternberg cell is present in it in a mixed inflammatory background then it proves hodgkins lymphoma.
Immunohistochemical tests should be done in the biopsy sample and hodgkins lymphoma will show the RS cells to be of B cell origin and will stain for cd 15 and cd 30 and will be negative for cd 45 and cd 20.
Regards
DR DE
Immunohistochemical tests to be done
Detailed Answer:
Hi
I would also advise you to do a bone marrow biopsy test.
If XXXXXXX sternberg cell is present in it in a mixed inflammatory background then it proves hodgkins lymphoma.
Immunohistochemical tests should be done in the biopsy sample and hodgkins lymphoma will show the RS cells to be of B cell origin and will stain for cd 15 and cd 30 and will be negative for cd 45 and cd 20.
Regards
DR DE
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thanks for responding quickly.
I myself dont see any mention of 'Reed sternberg' cell in the Biopsy report. Not sure why is it send further for Immunohistochemical test.
If XXXXXXX sternberg cells were there in the tissues/biopsy sample, i believe pathologist himself should be able to see it. Am i correct?
Is there any such possibility wherein pathologist is unable to see RS cell in the biopsy sample, however Immunohistochemical could trace it?
If RS cells are not seen in the biopsy sample, why the heck pathologist is telling me clear-cut its a Lymphoma and its curable .. dont worry and all that stuff as if its been concluded... Please advise!
Moreover, same was outcome of previously done Biopsy, i.e. no malignancy seen and no RS cells seen.
We are currently awaiting for Immunohistochemical test report.
Its been 6 months now we are literally dying out of stress/anxiety... :((((((
I myself dont see any mention of 'Reed sternberg' cell in the Biopsy report. Not sure why is it send further for Immunohistochemical test.
If XXXXXXX sternberg cells were there in the tissues/biopsy sample, i believe pathologist himself should be able to see it. Am i correct?
Is there any such possibility wherein pathologist is unable to see RS cell in the biopsy sample, however Immunohistochemical could trace it?
If RS cells are not seen in the biopsy sample, why the heck pathologist is telling me clear-cut its a Lymphoma and its curable .. dont worry and all that stuff as if its been concluded... Please advise!
Moreover, same was outcome of previously done Biopsy, i.e. no malignancy seen and no RS cells seen.
We are currently awaiting for Immunohistochemical test report.
Its been 6 months now we are literally dying out of stress/anxiety... :((((((
Brief Answer:
Positive for cd 15 and cd 30 is the confirmatory test
Detailed Answer:
Hi
If it is hodgkins lymphoma RS cells should be clearly seen by the pathologist.
However there is 25% chance of the pathologist to miss it and that is why you must wait for the immunohistochemical test to rule out hodgkins lymphoma.
If the stains in immunohistochemistry test are positive for cd 15 and cd 30 then you can be sure it is hodgkins lymphoma which is a curable disease with which proper treatment has a good prognosis.
If you have no more clarifications then please rate the answer and close the thread.
Regards
DR DE
Positive for cd 15 and cd 30 is the confirmatory test
Detailed Answer:
Hi
If it is hodgkins lymphoma RS cells should be clearly seen by the pathologist.
However there is 25% chance of the pathologist to miss it and that is why you must wait for the immunohistochemical test to rule out hodgkins lymphoma.
If the stains in immunohistochemistry test are positive for cd 15 and cd 30 then you can be sure it is hodgkins lymphoma which is a curable disease with which proper treatment has a good prognosis.
If you have no more clarifications then please rate the answer and close the thread.
Regards
DR DE
Note: For further queries related to kidney problems Click here.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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