My mother has been diagnosed with lymphoma after a ganglion biopsy at the end of July. 

71 years old, with slight thalassemia, osteoporosis, back problems, arterial hyper tension, anemic, 1.62m, 56kg.

She noticed in 2016 a no pain, lump under her jaw - decided to ignore it, and kept it from us. in march 2017 - noticed the lump to be getting bigger and decided to go to a doctor office and after a series of misdirection we went to Hematology in Clinical Hospital Coltea, Bucharest and was asked for biopsy.

2017.08.10 - Result ex. anatomy patology

Coltea Clinical Hospital, Bucharest

Anatomy Pathology-Histopathology

Anatomy-Pathology – Buletin Nr 343721 – 727 

Examination Date 10.08.2017  8:17

                                                F                      71 years

Exam. Anatomy - Pathology

Piece 1. Left Supra-Clavicular Lymphadenopathy (343   721-723)

Piece 2. Left Supra-Clavicular Lymphadenopathy (343   724-725)

Piece 3 Left Sub-Mandibular Lymphadenopathy (342   726-727)

MACROSCOPIC:

1.       One Lymphadenopathy with the diameter of 2.5cm, grey, greasy aspect on section.

2.       One Lymphadenopathy with the diameter of maxim 2cm, on section grey – of firm consistency.

3.       One Lymphadenopathy with the diameter of 2.5cm, on section grey – of firm consistency

EXTEMPORANEUS:

1.       Suggestive aspect for nonHodgkin malign lymphoma. Confirmation on paraffin.

HISTOPATOLOGY DIAGNOSTIC:

1.       (343   721 – extemporaneous , 343 722-723)

2.       (343   724-725)

3.       (343   726-727)

Lymphadenopathies with blurred/erased structure through a diffuse and nodular proliferation of lymphoid cells of small size, with relative rare mitosis;  numerous histiocytes with eosinophilic cytoplasm. Suggestive aspect for a nonHodgkin lymphoma with small size B cell of mantle type.

Immuno-histochemical Exam recommended.

Cod OMS 9673/3

Dr. Welt Luminita – Anatomy Pathology Primary Doctor

2017.08.29 - Monza Hospital - Onco Team Diagnostic - Result Ex. Immunity-hystochemical

Sent Diagnostic: Lymphoma under observation

RESULTS

Histopathology – microscopy:

-       Lympho-ganglion with architecture largely reshaped malignant lymphoid tumor proliferation, vaguely nodular with small cell, rounded nucleus, dense chromatina, rare pro-lymphocytes, isolated paraimunoblastic; isolated epitheliomas; rare reactive germicidal centers embedded in tumor proliferation

Imuno-Histochemical:

-       Tumor proliferation is positive for diffuse CD2, which expresses aberrant CD5 (T-marker, aberrant positive in some B lympho-proliferants) but is negative CD43 (T marker) expressing aberrant CD23 (dendritic marker, aberrant positive in some B lympho-proliferants) and is negative for Cyclin D1 and SOX11 (B mantle (MANTA) lymphoma markers)

Conclusions

-       Histopathologic aspect compatible with a nonHodgkin malign lymphoma with small B cell indolent, probably of type:  lymphocytic / B Chronic Lymphatic Leukemia ( B-SLL / B–CLL )

ICD-O:9823/3

Commentary:

-       Although the positivity for CD5 and for CD23 sustain a lymphocytic B lymphoma, the absence of the expression for CD43 and the nodular pattern do not permit the total exclusion of a nonHodgkin malign lymphoma with small cell B of marginal zone CD5 positive aberrant.

Medical Doctor Anatomy-pathology: Dr. Camelia Dobrea

Analysis validated by:  Dr. Ardeleanu Carmen

Release date: 14.09.2017

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After this the Doctor considered the diagnostic to be: Chronic Lymfocitic Leukemia (LLC) / Limfocitary lymphoma (SLL). LLC being excluded because of the normal number of lymphocytes present..

The doctor has requested further investigations - all results below.

2017.09.11 - Hiperdia - CT scan with contrast substance

Exam Date: 9.09.2017

Examination: CT neck, chest, abdomen, pelvis – all with contrast substance

Patient sent with LMNH diagnose

CT native exam with contrast substance – for chest, superior abdomen and pelvis shows:

-          Thyroid nodules on both sides, hipocaptant with diameters of maximum 12mm

-          Without pulmonary nodules or processes of alveolar condensation

-          Without accumulation of pleural- pericardial liquids

-          Without mediastinal – hilar lymphadenopathies

-          Axillar Lymphadenopathies on both sides – the biggest one with diameters of aprox 32/18mm in the left axil and in the right 21/12mm

-          Liver with normal dimensions, with aspect slightly fatty (steatosis) with a serous cyst of 7mm situated under capsule in segment VII; bile ducts intra and extrahepatic not dilated, alithiasic cholecist

-          Homogenous pancreas with normal diameters

-          Spleen with the cranio-caudal spindle of 10cm, homogenous, without vascular expansions (dilations) in hil

-          Kidneys with normal dimensions, are functional, with small expansions (dilations) skin-caliceal;

-          Uterus, urinary bladder in normal limits;

-          Without lymphadenopathies lumbar-aortic or peritoneal liquid

-          In the pelvis we observe a lymphadenopathy left external iliac with diameters of 35/18mm adjacent to the external iliac vessels, on the right with diameters of 22/11mm

-          Inguinal lymphadenopathies – the biggest one: 17/13mm in the right inguinal region

-          In the bone window – there are no modifications of the bone structure with osteolytic aspect or condensing on the examined segment

CT exam of the cervical region shows:

-          Rino, oro, hypopharynx and larynx cartilages with aspect in normal limits

-          left supra-clavicular lymphadenopathy of 22/14mm, on the right of 12/10mm

-          multiple ganglions sub-mandibular and jugular-carotid on both sides with short diameter of 10-12mm

CONCLUSIONS:

Multiple lymphadenopathies cervical, supra-clavicular, axillar, external iliac and inguinal bilateral. Thyroid nodules.

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2017.09.13 - Medlife Titan -  COLONOSCOPY Result

Indication: Non-Hodgkin lymphoma

Condition: minor thalassemia, anemic Fe deficiency associated syndrome, essential arterial hypertension in treatment with “Prestarium”

Allergies: No.

Sedation: Deep

RESULT: Examination until the ileocecal valve, fecal matter relative frequent on the tract which is partially aspirated. Multiple poles (? Cuduri) at the sigmoid level and at descendent level.

Supplementary loop on the transversal. Rare diverticula at sigmoid level. Without discernable lesions on the tract.

Date: 13.09.2017

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2017.09.14 - Monza Hospital - Onco Team Diagnostic - Result Ex Imuno-hystochemical - OsteoMedial Biopsy

Sent Diagnostic: Chronic Lymphatic Leukemia

RESULTS

Histopathology – microscopy:

-       Osteomedial biopsy (~18mm after processing) of one patient, aged 72years, sampled for the staging of a indolent lymphoma B (HP bulletin no 31427 / august 2017) ; the haematogenic marrow is with cellularity within the age range (40% cellular component) with the presence of all series;

o   - the erythroid series is normoblastic;

o   - ratio G / E ~ 2/1 (normal), granulocyte maturation present;

o   - normal megakaryocytes with conserved, dispersed lobulation.

Imuno-Histochemical:

CD20 is positive in small B lymphocytes isolated, reactive, CD23 negative.

Colorations:

Giemsa does not reveal the presence of mast cells.

Conclusions

There is no evidence of the presence of malignant lymphoid infiltrates on

the material examined.

Medic Anatomy-pathology: Dr. Camelia Dobrea

Analysis validated by:  Dr. Ardeleanu Carmen

Release date: 14.09.2017

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The doctor considers now the diagnostic to be Marginal Lymphoma and the patient to be kept under observation.

Please advise:

Why the change in diagnostic?

What diagnostics to be redone and after how much time?

What to do in the mean time? just wait?

Are there other alternatives? been reading about DCA...

Any help would be greatly appreciated. Thank you.