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What Does The Following FNAC Report Suggest?

Posted on Mon, 30 Jan 2017

Question: I need to know if a second opinion is warranted following a CT scan and fine needle aspiration biopsy. Attaching photo of CT report. Endoscopic ultrasound FNA biopsy showed no melignancy and shrinking of mesenteric lymph nodes, but lymph nodes still enlarged. Symptoms that led to CT was regular moderate to severe lower abdominal pain, discomfort and pain under right ribs, nausea, and fatigue. Treated before CT for secondary hyperparathyroidism.

Answered by Dr. Deepak Sundriyal (12 minutes later)

Brief Answer:
Hello dear. A repeat biopsy is warranted

Detailed Answer:
Hello dear. I have gone through the details. So in a case of enlarged abdominal nodes, sometimes a biopsy may turn out to be negative if it hit the necrotic part only. So a repeat biopsy is indicated before ruling out cancer. Otherwise XXXXXXX it may turn out to be tuberculosis which again is diagnosed only by biopsy. Please go ahead with a repeat biopsy.
Thanks and regards

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Deepak Sundriyal (53 minutes later)

I do have a history of pneumonia- 3 cases at birth, 3 years, and 22 years which I feel might give more insight for the pulmonary nodules. As for a second biopsy, is a FNA biopsy still an appropriate biopsy method or is something more invasive called for? Is it possible or unusual for mesenteric lymph nodes to be significantly enlarged but decrease in size when they are melignant? I do continue to often have moderate to severe pain in my abdomen and discomfort under right ribs into my back. Oncologist prescribed Bentyl for abdominal pain, but it does not give relief. Most recent bloodwork showed low calcium, protein and albumin.

Also, the oncologist has ordered a follow up CT of abdomen and pelvis and has added chest to the CT order, but that will not be until late April. That seems like quite a long time since initial CT was performed in late November and biopsy was in mid December.

Answered by Dr. Deepak Sundriyal (1 hour later)

Brief Answer:
Hello. Biopsy and not fna is required

Detailed Answer:
Hello dear. So pnuemonitis doesnot leave behind any nodules so it has no relation with current illness. Moreover, definite diagnosis can be made by a biopsy and not fna.
Mild variation in size can be there, but even that doesnot omit the need for biopsy. You should get a petct of whole body rather going for individual ct for different areas of body.
Please share the reports once available.
Thanks and regards

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Deepak Sundriyal (39 minutes later)

Thank you for your care and concern in answering questions. When you refer to need for biopsy, do you mean surgical? My current oncologist is very hesitant because he said it would be major surgery due to location of lymph nodes. Also, 3 cases of pneumonia would not cause scarring that would present as lung nodules on a CT? What part, if any, would the low calcium, protein, and albumin play in this? Is the comment about my liver listed on attached CT report a cause for concern? I'm trying to ride a fine line between concern and overreaction.

Answered by Dr. Deepak Sundriyal (3 minutes later)

Brief Answer:
Hello. Laparoscopic biopsy will be better

Detailed Answer:
Hello dear. If the radiologist is expert enough, he can do the biopsy under ctscan guidance. However, if it is not feasible then biopsy can be done by laparoscopic approach which is a minor surgical procedure. Pneumonia usually does not leave nodules, scarring may be there. Calcium protein and albumin have no direct relation , however a low albumin may signify chronic disease of any nature( be it malignancy, or some chronic infection). A small cyst has been reported in liver which is a normal finding. You please donot worry and go for the investigations sooner as possible.
Thanks

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Deepak Sundriyal (7 hours later)

I will follow up with my current oncologist. He told me that due to location in abdomen laparoscopic biopsy would not be able to locate lymph nodes in question.

Answered by Dr. Deepak Sundriyal (6 hours later)

Brief Answer:
Take opinion from your surgeon

Detailed Answer:
Hello dear.

I'd suggest you to take opinion from your surgeon for laparoscopic biopsy.

Thanks and regards

Note: For further queries related to kidney problems Click here.

Above answer was peer-reviewed by : Dr. Arnab Banerjee