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20922642 tn?1663074135

Pediatric PET Scan Report

This is the report from when my son had a PET scan. He has multiple enlarged lymph nodes in multiple different regions, as noted in the report.
I would like to know more about the "uptake" values and relating information if anyone would like to comment, or any other feedback that might be helpful or relevant. Thank you.

Reason For Exam
(PET Tumor Imag w/CT Skull to Thigh) Axillary mass, left

PET Report
Procedure: PET CT SKULL BASE TO MID THIGH INITIAL TREAT [78815]
Diagnosis: Axillary mass, left [R22.32 (ICD-10-CM)]
Indication:
Left axillary mass. Progressive transformation of germinal centers in left axilla status-post gross total resection. PET-CT to plan initial treatment and stage disease.
Technique:
PET-CT performed from midbrain to knees 1 hour after IV injection of 5.5 millicuries F 18-FDG. Blood glucose level 92 mg/dL.
Findings:
Moderate mucosal thickening and small amounts of loculated fluid in the maxillary sinuses consistent with sinusitis. Moderate increased soft tissue and abnormal uptake in the posterior nasopharynx with SUV max of 4.3 nonspecific but likely related to adenoidal tissue. Ill-defined uptake along the lower jaw line bilaterally the likely predominantly physiologic.
Increased number of small to enlarged bilateral neck lymph nodes especially in the mid and upper neck one of the largest of which is in the left upper neck with SUV max of 2.4 on image 31 being oval in shape measuring 1.6 cm.
Moderate left axillary and chest wall adenopathy with numerous enlarged lymph nodes with low to intermediate uptake with SUV max ranging up to 2.3. There is either a necrotic lymph node measuring 2.6 cm or a fluid collection in the left axilla and chest wall. Other lymph nodes in the left chest wall and axilla measure predominantly 1.8 cm and less in diameter. Few mildly prominent lymph nodes in the right axilla measure up to 8 mm with the most distinct lymph node having SUV max of 2.4. Findings are suggestive of lymphomatous involvement of lymph nodes in the axilla and chest wall
and to a lesser extent in the neck.

PET Report
Moderate increased soft tissue and uptake in the anterior mediastinum is most likely related to physiologic thymic uptake with prominence of the thymus with SUV max of 2.5. No definite hilar or mediastinal hypermetabolic adenopathy. Patchy ground-glass and denser opacity throughout both lungs most marked dependently could be related to combination of atelectasis and/or possible mild infiltrate. Minimal amount of platelike atelectasis in the lungs also. Some of the pulmonary opacity has very minimal uptake.
Spleen is normal in size and uptake. Moderate amounts of stool in the colon consistent with constipation. No hypermetabolic adenopathy or other hypermetabolism in the abdomen or pelvis to suggest malignancy. Remainder negative.

Best Answer
1081992 tn?1389903637
COMMUNITY LEADER
Hi, here are some guesses. Those SUVs are low-ish. Generally, that could mean low grade lymphoma, or else just being inflammatory/physiologic. Being >10 or >13 would generally mean aggressive lymphoma. But there are no hard rules for SUVs, anything is possible.

In your profile, you list autoimmunity plus granulomas, suggesting that family history. So if there were no biopsy proven lymphoma, altogether there is ambiguity and there wouldn't be reason enough to believe there is lymphoma. There is, e.g., that one spot which is either fluid (i.e., not-cancer) or else it is necrotic -- which in turn can be cancer, or not-cancer (such as some granulomatous disease).

Sometimes, granulomas form because there is some real disease like TB, which is usually mainly in chest and neck. But sometimes granulomas form for mysterious immune system dysfunction, as with Wegener's or sarcoidosis, also in the chest and neck.
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7829575/  "Causes of necrotic features in fine-needle aspirates from cervical lymph nodes"  2021)

But since apparently there is biopsy proven lymphoma, then it's reasonable to suspect that all enlarged nodes might be lymphoma.

However, the one large node is oval, which tends toward that one being not-cancer. Lymphoma  tends to make nodes get rounded.

The node sizes are not very large. Overall, there is ambiguity. So if the biopsy also has ambiguity, that changes everything. But if the biopsy is very certain, then many of those other nodes could merely be reacting to the lymphoma (and are not-cancer) - which would mean the lymphoma is not spreading rapidly.

Yes, it's complicated. Are you suspecting that it's not really lymphoma? It's possible to ask for a review of the biopsy.
1 Comments
I wanted to follow up earlier on this comment but didn't get the chance till now. So you hit on a key point because you had made note that one of my tags referenced granulomas. I am impressed because this is exactly what has brought me here. My mom unexpectedly died last June.  Just for a little back story, she had three stents put in her heart over a course of about 10 days, undergoing an angiogram on three separate occasions and all of which epically failed to be placed correctly. Anyways, she was placed in two separate ICU's. The first one she was taken by ambulance over an hour away, the next she was taken by airflight about four hours away. She was placed on a ventilator on her third day at the first ICU. Those were the werst 12 days of my life. Kind of irrelevant though to my original concern.
Anyways, since she died, I have been looking over her records from her primary provider. She had COPD but was only 61 when she died. She had gotten progressively worse after having influenza A in Feb 2020. That is when her decline had started. While reviewing the reports from the many tests they ran, I couldn't ignore anymore that the radiologist's repeatedly sighted "Old Grandulamoutos Disease". I finally looked this up. It is rare, and it is genetic .  
I cannot find in any of the thousands of pages, where her primary doctor addresses or references this Granulomatous Disease to her. In all appearances, it seems that she was unaware of ever even having this. Anyways, I'm sure you're getting my point by now. I'm afraid this disease has been passed down to my son.
        
One of the tell-tale characteristics is having multiple occurrences of pneumonia. Now when my son was about 4, he got a cough that seemed to have stuck around for about 2 years straight. This is around the same time of first noticing his lymph nodes bulging. He ended up having pneumonia 4 times in about a year and a half. Noted from PET Scan:
                     Patchy ground-glass and denser opacity throughout both lungs most marked dependently could be related
                     to combination of atelectasis and/or possible mild infiltrate. Minimal amount of platelike atelectasis in the lungs also.
                     Some of the pulmonary opacity has very minimal uptake.
                     Patchy opacity in the lungs should be primarily related to atelectasis or some component of mild inflammation. Other
                     findings as above.
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1081992 tn?1389903637
COMMUNITY LEADER
"I'm curious what made you say it's a lymphoma"
From this: 'status-post gross total resection' apparently says that there was a surgical biopsy (not merely a needle biopsy).

...and then this: 'PET-CT to plan initial treatment and stage disease' which is what's done after a diagnosis has already been made by biopsy.  

Can you post the biopsy report?



Helpful - 1
2 Comments
Yes, I definitely will. I have been trying to find it in my files, so as soon as I do, I will post it. Also, to explain a little about those two statements, they did remove one of his axillary lymph nodes during the biopsy, mainly I think because if it did end up being malignant then they would remove it anyways, and also because at that point, it was already considered to be a legion of some kind. The other statement I actually re-read myself when I posted it because it stuck out to me as well. I have read these reports numerous times, but still things pop out that didn't before. What I'm sure they are referencing is from the diagnosis of the Progressive Transformation of the Germinal Centers.
It was Children's Hospital in Minneapolis.  Also, I'm curious where are the doctors that you referenced from?
1081992 tn?1389903637
COMMUNITY LEADER
Btw, the thymus is where T-cells go to mature. Killer T-cells fight cancer, but they also fight virus and other infections. Other subtypes of T-cells have different jobs. The low SUV in the thymus says the T-cells are probably multiplying to fight something.
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1 Comments
Thank you for the information. I'm curious what made you say it's a lymphoma...if I'm understanding this correctly that you have this impression?
1081992 tn?1389903637
COMMUNITY LEADER
Minor things about the axillary path report:
"aggregate of lymph nodes measuring 3.0 x 2.5 x 1.0 cm."
Round is bad, oval is good. That is round. But in actuality, it probably was two together. Two ovals can make a round.

"lmmunohistochemical..."
That'd be the flow cytometry. It generally looks for ceratin protein molecules found on a cell surface. Such as the CD5 etc that has been mentioned. Different immune cells have different CDs on their surface, and for example B-cells are the only ones with CD20.

"...and/or in-situ hybridization"
That's the FISH I'd mentioned. The ISH in FISH. It generally looks for mutations in cell DNA.

From the other biopsy:
"left inguinal
2.0 x 0.8 x 0.7 cm"
That's oval, which is good. Do you remember if they did an ultrasound on that node, before biopsy?

About saying "we"?
That's you the patient's mother, and me. In a cooperative effort. So as not to appear to be talking down to anybody. But if that's confusing, I should stop saying it that way :)


Angela, please remind me of what questions I've not answered.

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1 Comments
Oh, "PA" is for Pennsylvania.
1081992 tn?1389903637
COMMUNITY LEADER
"I thought I had specified that he was diagnosed with PTGC already..."
Yes, you certainly did. But I didn't know if that was the only diagnosis. They can coexist. Also, there were scattered references to "suspicious of lymphoma" and "suggestive" of lymphoma. But all that is cleared up now from the axillary path report. Lymphoma is off the table. There is no lymphoma.

So let's move immediately to your most pressing question:
"Also, can a person be borderline or on the verge of cancer developing?"
From what I've read, the chance is very small, at 1-2%. Also, the studies show that there is that small association, but **association is not causation**. If you want to go into great detail on this, please start a new post - so things don't get lost in this long one.

"How might this relate to Granulomatous Disease, if at all?"
I think it certainly does, because having one kind of immune dysfunction makes having other kinds of immune dysfunction more likely. Please start another post on this topic, it's very interesting. Also, doing that might help you to understand what happened to your mother. IIRC, enlarged heart, with no significant atherosclerosis/blockage, is what caused the heart attacks. Her immune system going awry was probably behind that somehow. And the repeat stenting is also odd.

There's also the pattern in your sons lungs, IIRC similar to hers, as you've pointed out.

"Also, and maybe you have no idea, which is fine obviously, but what would have to change for it to turn into a cancer?"
Inflammation can tend toward developing malignancy. Every time a cell divides, there is a chance for a mistake to occur - a mutation. Inflammation can lead to an increased rate of cell division. In fact, that's why a PET lights up on areas of cancer AND inflammation: there is increased "metabolic activity" in each.

Also, dysfunctional immunity can mean that bad cells don't get destroyed as they should. Also, inflammation around new cancer cells makes them more likely to thrive, rather than just fizzle out.

"Also, is the NLPHL the only one that it could turn into?"
Offhand, that's the only one I've seen "associated". But we can look into other possible sequelae or long term complications.

"...I search the different terminologies, and references that are in his reports."
Excellent. And that's burdensome at first, having to learn all the new terms. So bravo.

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1081992 tn?1389903637
COMMUNITY LEADER
Angela, I think we've got this figured out. It's good news.

-- Your son has PTGC, which can create a lot of enlarged nodes - just as lymphoma can, but lymphoma is cancer and PTGC is not-cancer. Other words for not-cancer are "benign" and "reactive".

-- Even for a pathologist using a microscope, PTGC looks a lot like a certain rare type of lymphoma called Nodular Lymphocyte Dependent Hodgkin Lymphoma (NLPHL). Both even tend to occur in young children.  

-- At some point, there was talk of a treatment plan. But PTGC is not treated, they just leave it alone and it plateaus out or even shrinks on its own. So when they discussed treatment, they might have still believed it was NLPHL. (But then NLPHL is 'indolent', which means 'slow growing'; so we have to keep that in mind as indolent lymphomas grow so slowly that they might not get treated for a long time anyway. Nothing is simple here, sorry.)

-- Further analyzing/testing of the excised node might have confirmed that it is PTGC (not-cancer). This is what to hope for. It's not only the best outcome, it's probably also the most likely.

-- What we want is to see the path report say that it is PTGC, not Hodgkin Lymphoma. Or else followup testing like 'flow cytometry' saying it is PTGC not Hodgkin Lymphoma.

-----------------------------skip the rest below if you like-------

I'll just post these here for the future:

[The 1st is very technical, about the difficulty in telling the good from the bad condition. Note that it's recent. But don't tackle that yet.]
Pitfalls in the Diagnosis of Nodular Lymphocyte Predominant Hodgkin Lymphoma: Variant Patterns, Borderlines and Mimics  2021
https://www.mdpi.com/2072-6694/13/12/3021/htm
"The key feature that permits the separation of PTGC from NLPHL is the lack of LP cells in PTGC, along with the lack of PD1 rings. Identifying LP cells, however, may be confounded by prominent centroblasts, follicular dendritic cells and histiocytes, which may falsely impart a resemblance to LP cells. In such cases, looking for extranodular LP cells can provide an important clue. Furthermore, while both entities show a range of misshapen nodular structures, NLPHL nodules frequently exhibit ragged outlines in comparison to PTGC nodules, as best visualized on an IgD stain. A BCL2 stain can also provide helpful information, although the BCL2 expression in paracortical T-cell zones makes the visualization of a clear separation from mantle zone B cells less optimal. Increased IgG4-positive cells have been described in association with PTGC but not NLPHL, and therefore, IgG4 is another useful marker to separate PTGC from NLPHL [51]. Given the often-subtle differences between PTGC and NLPHL, awareness is important to avoid misdiagnosis."


[Te 2nd one refers to PET, in PTGC versus Hodgkin Lymphoma. Your son's PET report did not look like Hodgkin Lymphoma to me.]
Progressive Transformation of Germinal Centers in a Pediatric Patient Initial Evaluation and Follow-Up With Serial F-18 FDG PET/CT Imaging  2011
https://journals.lww.com/nuclearmed/Abstract/2011/10000/Progressive_Transformation_of_Germinal_Centers_in.38.aspx
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1 Comments

I have to apologize because I thought I had specified that he was diagnosed with PTGC already. I realize I have posted a lot of information so far, and it gets a bit cluttered when clicking on the different "comment" options. I was going to just send you the info in a pm, but the characters allowed are a lot less than on here. If you're interested, I could e-mail you the other docs? I think that would make things a lot easier.
I am definitely going to look up what you shared. I have been searching what NLPHL would "almost" look like.
So, this is what I am wondering:
How might this relate to Granulomatous Disease, if at all?
Also, can a person be borderline or on the verge of cancer developing?
Also, and maybe you have no idea, which is fine obviously, but what would have to change for it to turn into a cancer?
Also, is the NLPHL the only one that it could turn into?
I ask this because of what my different searches ping. I search the different terminologies, and references that are in his reports. Most of the things I have searched, return results that talk about different lymphomas.
If at all possible, I'd be happy to share more via email. Please let me know either way.
Also, last thing, your profile indicates PE. So, you're a physician's assistant? I'm curious who are the "we" are that you reference?
Again, thank you Ken for all of your help. It is very much appreciated.

Last last thing.... I posted a big note on your profile, and so i had to break it up into numerous smaller notes. I was frustrated after I realized that the beginning "note" is actually the last one from me on the list. If you get the chance to read them, hopefully it won't be too jumbled up. As long as you read the first one first, which starts with "Good Morning", and maybe you already have.
Anyway, I look forward to hearing what your thoughts are on the Pathology Reports, and what your answers are to some of my questions.
Have a great night!!
1081992 tn?1389903637
COMMUNITY LEADER
Why is a PET scan ever done? It generally goes like this:

A bump is found. If it's very suspicious, then a scan, usually an UltraSound, is done to measure the dimensions. Oval is good, rounded is probably bad. The US scan can also see the inside of the node, to look for signs of cancer. (E.g., if the inside is destroyed.)

If the scan is tending to something bad, then next comes a biopsy. There are two choices. If the node looks only somewhat bad, a biopsy sample will be taken with a hypodermic needle. But if the node seems really bad, then a surgical resection is done. A resection gives much more sure results, because they can examine the whole excised node.

If the biopsy finds cancer, then next a PET scan might be done. It's something like a whole body snapshot, done to see if the cancer has spread or not. It looks like a photograph negative, except some spots "light up" from either inflammation or from cancer. In your son's case, the results look like various spots of probable inflammation - and are not like what would probably be expected from cancer. Also, if the biopsies did not find any cancer, then any spots on the PET that light up are likely not-cancer.

Sorry, it's complicated but nothing is simple. It will take a while to absorb, especially since your son's case is not straightforward - which is better than being a straightforward case of lymphoma.
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Hey! Here is the first pathology report:

SURGICAL PATHOLOGY REPORT

ACCESSION NUMBER: MS 17 - PROCEDURE: 11/15/2017 RECEIVED: 11/15/2017
DIAGNOSIS:
Lymph node, left axilla, excisional biopsy:
- Reactive lymphadenopathy with follicular hyperplasia and progressive transformation of
germinal centers. (See comment.)
COMMENT:
Progressive transformation of germinal centers is a benign reactive process, which in a minority of cases may be associated with
synchronous or metachronous development of nodular lymphocyte predominant Hodgkin lymphoma. There is no evidence of
lymphoma in this case.
Preliminary differential diagnosis was discussed with Dr. Jul on the morning of 11 /16/17. Dr. Gab has also
reviewed this case and she agrees with this diagnosis.
MKD/11/17/1711:30
CLINICAL HISTORY:
***Electronically Signed Out•••
Phop, MD
Pathologist
4 year old male with enlarged axillary nodes and left neck lymph nodes. Suspicious for malignancy. Painless mass with marked
lymphadenopathy in the left neck (up to 1.5 cm). No chest mass. Possible right pulmonary embolus. Cat scratch titers negative.
Normal white blood count with neutrophilia. LDH normal.
SPECIMEN(S) REC'D:
Left axilla lymph node
GROSS DESCRIPTION:
A single specimen is received fresh, labeled "left axilla lymph node" and consists of a large lobulated, pale tan lymph node or
aggregate of lymph nodes measuring 3.0 x 2.5 x 1.0 cm. Representative fresh tissue is retained in two containers of RPMI for
future studies. Additional tissue is snap frozen and retained at -70°C (Department of Pathology). Five touch preparations are
performed, including one alcohol-fixed H&E stained and one air-dried Diff Quik stain. The three others are retained air-dried and
unstained. Additional fresh tissue is submitted sterilely for microbiology studies (bacterial, fungal, and acid fast cultures). The
remaining tissue is entirely submitted in cassettes 1 and 2 for microscopic study.
CAV/11/15/2017 Pishop, MD
Prabhavathi Chintapalli, HT (ASCP)


MICROSCOPIC:

SURGICAL PATHOLOGY REPORT
Page 2 of 2
MS17-
1 H+E and 1 Diff Quik touch preparation, 2 H+E sections. lmmunohistochemistry: 1 CD3, 1 CD20, 1 CD21, 1 CD15, 1 CD30, 1
BCL6, 1 Oct2. The controls are appropriate. Touch preparations demonstrate any heterogeneous population of small and large
lymphocytes with occasional tingible body macrophages, rare neutrophils, and rare eosinophils. Reed-Sternberg cells are not seen,
and there is no other evidence of cytologic atypia. No granulomas are detected. Sections of the lymph node tissue demonstrate
variably sized enlarged lymphoid follicles with focal transformation of germinal centers, indicated by small lymphocytes infiltrating
the germinal center. There is also interfollicular and paracortical expansion with high endothelial venules. Rare histiocyte-like cells
are noted. lmmunohistochemistry for CD3 and CD20 highlight a mixed population with variably sized CD20 positive germinal
centers, interfollicular monocytoid B cells, and predominantly T lymphocytes in the interfollicular zone. CD21 highlights the reticular
network, including expansion within transformed germinal centers. CD15 highlights a few scattered individual small cells. CD30
stain highlights occasional cells surrounding the follicles with membranous and Golgi pattern. OCT2 and BCL6 highlight germinal
centers, mantle zones cells, and occasional interfollicular cells. LP cells are not highlighted.




This part is the disclaimer at the bottom: Probably unimportant but just in case you wanted reference.
lmmunohistochemical and/or in-situ hybridization testing used in this case was developed and its performance characteristics determined by Children's Hospitals
and Clinics of Minnesota Laboratories or its reference laboratory. Although some reagents used for this testing have not been cleared or approved by the US Food and
Drug Administration, the FDA has determined that such clearance or approval is not required. It is used for clinical purposes and should not be regarded as
investigalional or for research. This laboratory and its reference laboratories are certified under the Clinical Laboratory Improvement Amendments (CL/A) as qualified to
perform high complexity clinical laboratory testing.
Children's Hospitals
This is the second Pathology repot from the groin biopsy: (This one has much less detail than the first. No staining)

SURGICAL PATHOLOGY REPORT
ACCESSION NUMBER: MS19-659 PROCEDURE: 3/4/2019 RECEIVED: 3/4/2019
DIAGNOSIS:
Lymph node, left inguinal, biopsy:
Reactive follicular and paracortical lymphoid hyperplasia.
Collections of monocytoid B-cells.
COMMENT:
The findings are those of benign reactive lymphadenopathy. Dr. Gab reviewed this case and agrees with the
interpretation.
CAG/03/05/19 11 :32
CLINICAL HISTORY:
***Electronically Signed Out***
, MD
Pathologist
Five-year, six-month-old male with a history of left axillary reactive lymphadenopathy with follicular hyperplasia and progressive
transformation of germinal centers (MS 17-3988) presents with an enlarged left inguinal lymph node.
SPECIMEN(S) REC'D:
Lymph node, left inguinal
GROSS DESCRIPTION:
Received fresh, labeled with the patient's name, demographics, and designated "left inguinal lymph node" is a thinly encapsulated
2.0 x 0.8 x 0.7 cm pink-tan lymph node with a homogeneous pink-tan cut surface. Touch preparations are obtained. A piece is
placed in RPMI for potential flow cytometry.
Summary of sections: 1 - left inguinal lymph node. (Jar 0),
SLK/3/4/2019 Llliani, MD

MICROSCOPIC:

Wright stained imprints of the left inguinal lymph node show a polymorphic population of lymphoid cells. Sections show prominent lymphoid follicles with active germinal centers containing many tingible body macrophages, focally paracortical expansion, scattered collections of monocytoid 8-cells in the sinuses, and few micro-clusters of epithelioid histiocytes. No proliferation of atypical cells is seen.
1081992 tn?1389903637
COMMUNITY LEADER
Here is why the path report on the axillary biopsy is of prime importance. Everything up until the biopsy is merely justification to perform the biopsy. The results determine what happens afterwards.

Docs can't do a biopsy on everybody with swollen nodes. It's a risk versus benefit analysis. Often, a biopsy can be a way to rule out lymphoma. Then the real cause of the swollen nodes can be pursued.

If scans point toward lymphoma, the biopsy is a way to confirm that. Scans and blood tests alone can't confirm anything.

Still, sometimes a biopsy shows lymphoma, even though scans and other preliminary evidence tended toward immune dysfunction. A lymphoma can even cause immune dysfunction. But that is the RAREST possibility.

To my mind, everything with your son points to immune dysfunction. But we need to see the path report to be 99% sure.

If the path report is equivocal/ambiguous, then we'd look to family history (Fx) and all the rest to tip the scales.


Btw, what usually happens when docs find a cancer is that an appointment is set up to begin treatment ASAP. That's usually, but not always, the case. That apparently didn't happen with your son. We should want to know why not. If there is no cancer, then why was the PET done? (Sometimes, treatment for a slow growing lymphoma can be put off for years.)

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1081992 tn?1389903637
COMMUNITY LEADER
The one crucial piece is still missing. That's the path report on the axillary node.
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Hey Ken! I hope you had a nice weekend!! :)
Thank you for getting back to me. I will include more info from the appointments he had, so I'm editing them right now and pasting the info together. Obviously, it will be in chronological order, starting with the first visit to Children's. I'll post it as soon as i'm done, hopefully it won't take long. I'm curious to see what you think after having more of the whole picture, instead of just bits and pieces. Anyways, then I am going to follow up with a message to you.
1081992 tn?1389903637
COMMUNITY LEADER
"A piece is placed in RPMI for potential flow cytometry."
We want to see that report, for 'flow cytometry'. That's *if* it was done.
Also anything that says 'FISH'.

"Findings are suggestive of lymphomatous involvement of lymph nodes in the axilla and chest wall and to a lesser extent in the neck."
That radiologist might have concluded differently, if they were aware of the family history (Fx) of immune oddities.

"old granulomatous disease"
with "old" meaning it was there for a long time, not recent. But let's leave that for later. EXCEPT that whenever you talk to any doc about your son, you tell them about your mother. Every time.

"Reed-Sternberg cells are not seen"
That's sort of ruling out Hodgkin's Lymphoma (as opposed to non-Hodgkin's Lymphoma, which never has Reed-Sternberg cells)


Angela, at this point I don't see why the PET/CT was even done. The biopsy results seem at most equivocal. (There's the BCL-6 for discussion at a later point.) Even the excised node was oval, not round.

Didn't any doc tell you what the diagnosis is??? Is this Mayo?


[I'm trying not to say that I think somebody jumped the gun in ordering the PET and talking about treatment.]
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3 Comments
I feel badly because I probably have made things a little confusing. Sorry about that, I will try not to jump around so much.
To explain a bit, the first biopsy resulted with him being diagnosed with PTGC. They also "can't rule out a pulmonary embol"(lung). It was a combination of the findings that made them decide to go with a PET scan. PTGC can turn into one of the Hodgkins Lymphomas.
So what would a flow cytometry show them? Also why do you say that about the Bcl6 detection?  
Also he was positive for CD19 amd CD5.
What could  that possibly mean?
Also, I'm wondering why he may not have needed the PET scan in the first place?
1081992 tn?1389903637
COMMUNITY LEADER
Another oddity, the path report says "SPECIMEN(S) REC'D: Lymph node, left inguinal"
inguinal, not axillary

Which person are we talking about there??
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My son. So, he had two separate biopsies. The first was his arm pit, and second was his abdomen area.
1081992 tn?1389903637
COMMUNITY LEADER
"Kind of irrelevant though"
Maybe not.

And do you mean "Chronic granulomatous disease"?

Can you get the biopsy report on the portal? The sooner the better.

The docs believe he has lymphoma. That is what they are proceeding on.

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7 Comments
Is there a way to upload on here? The report is in a format that I cannot cut and copy.
Disregard the previous question please.
This is from the first Pathology report:

1 H+E and 1 Diff Quik touch preparation, 2 H+E sections. lmmunohistochemistry: 1 CD3, 1 CD20, 1 CD21, 1 CD15, 1 CD30, 1
BCL6, 1 Oct2. The controls are appropriate. Touch preparations demonstrate any heterogeneous population of small and large
lymphocytes with occasional tingible body macrophages, rare neutrophils, and rare eosinophi ls. Reed-Sternberg cells are not seen,
and there is no other evidence of cytologic atypia. No granulomas are detected. Sections of the lymph node tissue demonstrate
variably sized enlarged lymphoid follicles with focal transformation of germinal centers, indicated by small lymphocytes infiltrating
the germinal center. There is also interfollicular and paracortical expansion with high endothelial venules. Rare histiocyte-like cells
are noted. lmmunohistochemistry for CD3 and CD20 highlight a mixed population with variably sized CD20 positive germinal
centers, interfollicular monocytoid B cells, and predominantly T lymphocytes in the interfollicular zone. CD21 highlights the reticular
network, including expansion within transformed germinal centers. CD15 highlights a few scattered individual small cells. CD30
stain highlights occasional cells surrounding the follicles with membranous and Golgi pattern. OCT2 and BCL6 highlight germinal
centers, mantle zones cells, and occasional interfollicular cells. LP cells are not highlighted.
Also, to answer your question, it is never referred to as "Cronic" Granulomatous Disease, always "Old" for some reason.
This is from one of her x-rays:
XR CHEST AP PORTABLE: 6/22/2020 20:03 CDT INDICATION: R06.02: SHORTNESS OF BREATH COMPARISON: June 8, 2020 TECHNIQUE: AP upright portable FINDINGS:
There is mild cardiomegaly without failure. There is hyperaeration lung field as seen previously compatible with COPD. Multiple granulomata consistent old granulomatous disease. Eventration the right hemidiaphragm unchanged. No acute infiltrate seen. IMPRESSION: 1. Cardiomegaly without failure. 2. Old granulomatous disease. 3. Eventration the right hemidiaphragm 4. No acute lung disease
This is another xray report:

Lung window images patient has evidence for old granulomatous disease with a
diffuse multiple calcified granulomata.. Diffuse emphysematous changes.
Mediastinal window images show no adenopathy..
Bone settings: Degenerative changes
IMPRESSION:
1. Old granulomatous disease with multiple calcified granulomata.
2. Emphysematous changes.
3. No acute abnormality.
Another REport:

Lungs: There is mild increase in interstitial markings within the lungs. This is nonspecific. No pneumonia or pulmonary edema is present. Scattered punctate calcifications are present compatible with old granulomatous disease. Pleural spaces: Unremarkable. No pleural effusion. No pneumothorax. Heart/Mediastinum: Unremarkable. No cardiomegaly. Bones/joints: Mild convex right thoracic scoliosis is present. IMPRESSION: Chronic appearing interstitial change and sequela of old granulomatous disease as above. No acute cardiopulmonary disease identified
This is the second Pathology Report, this one is much less detailed:

SPECIMEN(S) REC'D:
Lymph node, left inguinal
GROSS DESCRIPTION:
Received fresh, labeled with the patient's name, demographics, and designated "left inguinal lymph node" is a thi nly encapsulated
2.0 x 0.8 x 0.7 cm pink-tan lymph node with a homogeneous pink-tan cut surface. Touch preparations are obtained. A piece is
placed in RPMI for potential flow cytometry.

MICROSCOPIC:
Wright stained imprints of the left inguinal lymph node show a polymorphic population of lymphoid cells. Sections show prominent
lymphoid follicles with active germinal centers containing many tingible body macrophages, focally paracortical expansion,
scattered collections of monocytoid B-cells in the sinuses, and few micro-clusters of epithelioid histiocytes. No proliferation of
atypical cells is seen
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