"Also this states lymph nodes up to 12mm are totally healthy normal resting nodes"
Can you quote that? I don't see that on your cited page.
"Also it says cyclin D 1 is positive in scatter T cells…"
Well now, that might be promising, Spartan. I'd want to know why that is there.
Here's my speculation: the path looked for it because cyclin D1 is found to be *overexpressed* in certain cancers/lymphomas. Meaning there's lots of it. But you apparently don't have lots, you just have some scattered about.
Let's say that cyclin D1 is like a growth factor, it makes cells multiply. So what benign not-cancer conditions exist, where there is some, but not a lot, of cyclin D1? Does every reactive node have it? I don't know, but I'd guess not. If it's true that having some cyclin D1 is not usual in reactive nodes, then that might be a big clue as to what not-cancer effect is making your nodes enlarge.
They would probably say that both methods are equivalent. I wouldn't argue with that. The fluorescence microscopy does have the advantage of showing where the cells are at - and yours are where they belong.
I don't think they need to do both. What was done is fine.
... the gross exam done by the initial pathologist.
They would send out an adequate amount. Some gets stored, and that's how a future 2nd opinion can be had.
"Just trying to understand it all."
First is 'gross' exam, just by eye.
Next, slices are taken and looked at with a microscope. Various stains are used, which help to e.g. tell one type of cell from another.
Then comes fluorescence. Imagine a huge number of tiny tiny manufactured darts. Each type can only stick to one particular type of target. The tail feathers glow under UV light, so that the darts can be easily seen.
For fluorescence microscopy, they start with a thin slice of your node. Then over that they put a solution with huge numbers of tiny darts manufactured to stick only to something called BCL2 *that's the bad thing, which is found on the surface of certain cancer cells). Then rinse. With the microscope, they can now see wherever those darts stuck. Just like the type of photograph of the earth at night taken from way above, they can see the specks of light.
For flow cytometry, it is the same except the sample is not a whole slice, it gets broken up into individual cells. The cells are put in a flow past a light sensorm, 1 by 1 but large numbers are done because the flow goes so quick. This way is more likely to spot individual specks if they exist. It's more comprehensive, just as a resection biopsy is more comprehensive than a needle biopsy.
As for shrinking? The overall size should be reported as part of the gross exam.
The size of the resected node? It's larger than a 'resting' node, but typical for a normally reactive node.
Apparently, they chose that one because the risk (of harming a nerve or blood vessel) was much greater for the big ones than for this smaller but more available one.
That report looks like 'fluorescence microscopy', not flow cytometry. It's sort of the same approach. It's saying that the different types of immune cells are in their respective expected places, not growing all over as would be in a cancer. It also didn't spot any cancer cells (no BCL2).
They might still do flow cytometry. I dunno.
"Even with its normal size would you still expect it to rule out something in the larger nodes given it’s in the same area?"
Yes, that's what would be expected. Bad cells would have spread to the node that was taken. If you get a flow cytometry report, let me know.
JOHN P. LEE, D.O. Gross Description Labeled left submandibular lymph node received fresh is a 10 x 7 x 6 mm pink-tan lymph node. The lymph node is serially sectioned and a portion is sent to Mayo for flow cytometry. T/E, blocks 1A1B CHRISTINE A. FRIDAY Billing Fee Code(s): 1: GMC3 - 88305, CD20 - 88342, IHC 88341, IHC 88341, IHC 88341, IHC 88341, IHC 88341, IHC 88341, IHC 88341 SNOMED Code(s): 1: P1100 T08000 T08160 ACCESSION CoPath Report Date: 05/09/2022 12:41
Microscopic examination is performed and supports the diagnosis. Sections show normal lymph node architecture. CD3 and CD5 highlight interfollicular T cells. The B cells are highlighted by CD20. The germinal centers are highlighted by BCL6 and CD10. The germinal centers are negative for BCL2. CD23 highlights the dendritic meshwork of the germinal centers. Cyclin D1 is positive in scatter T cells
That’s the test description. Is that stating the flow cytometry results or is that separate from this? I just see where a chunk was sent to Mayo.
UPDATE: the lymph node they took was only 10 by 7 by 6 MM. I’m so confused by this. Why would they take that one when I had so many over a CM long? Why would they take that one when I have that are now over 3 CM in length that BOTH increased in size over the course of 3 years?
I just feel defeated. I feel like we did all this now only to have not gotten the right one. I don’t get it, I don’t get why he took that one.
Even with its normal size would you still expect it to rule out something in the larger nodes given it’s in the same area? That size node doesn’t seem enlarged does it?