Dr. Goswami Parth Rajendragiri
Pathology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I had a core biopsy done on an enlarged axillary lymph node. The pathologist had asked for a larger sample. Some CD (cluster of differentiation) tumor markers have shown up on the first biopsy. I need help interpreting the pathology report. I was diagnosed with right breast cancer thirteen years back. I had ultrasonography of my lymph nodes performed. Does this look like Hodgkin's lymphoma?
Hello,
Welcome to icliniq.com.
Following is my opinion on your asked question. CD (cluster of differentiation) 30 and pax gene can be positive in Hodgkin's lymphoma. However, your result is positive for cyclin D, which is positive in mantle cells, and CD 20, which is positive in B cell neoplasm. So, the result is not conclusive to rule out any lymphoma. I suspect a strong possibility of lymphoma as per the attached reports (attachments removed to preserve the patient's identity). I suggest you repeat the biopsy and immunohistochemistry (IHC) report for a more conclusive result. I hope I have answered your question. Let me know if I can assist you further. Best Regards.
Patient's Query
Hello doctor,
What about the R-S cells. I know they are linked with Hodgkin lymphoma. Pathology report says some highly atypical cells “resemble” R-S. Would the pathology report be pretty certain?
Hello,
Welcome back to icliniq.com.
Following is my other answer to your questions. Actually, in your attached report (attachment removed to preserve the patient's identity), the focus of atypical cells is present. The report has mentioned that atypical cells resemble RS (Reed-Sternberg) cells. The pathologist in that report is not sure that these cells are RS cells. You are right; RS cells are seen in Hodgkin's lymphoma. But here, that atypical cell's morphology (microscopic appearance) does not indeed suggest RS cell morphology. So, I suggest repeat sample advice. A pathology report, especially histopathology done in your case, is conclusive in ruling out lymphoma. However, in your case in the report, any type of lymphoma cannot be ruled out conclusively. I suggest you discuss the management plan and repeat the biopsy with your doctor after your doctor also agrees with it. I hope this information will be helpful to you while doing a discussion with your doctor. Let me know if I can assist you further.
Patient's Query
Hello doctor,
I have had an excisional biopsy done on the axilla. I am waiting for the final pathology report. I am trying to understand if this could be some lymphoma. Can CD tumor markers such as CD 30, pax 5, and 20 show up on reactive or benign cells? Also, can you explain the microscopic findings? Does anything besides the RS cells look like it can be cancerous?
Hello,
Welcome back to icliniq.com.
In the case of lymphoma, malignant lymphoid cells are present with a high nucleus: cytoplasmic ratio and prominent nucleoli. In lymphoma, there is effacement of lymph node architecture. RS (Reed-Sternberg) cell would be present in the case of Hodgkin's lymphoma. In Hodgkin's lymphoma, CD (cluster of differentiation) 15 and CD 30 are positive with weak pax 5 gene positivity. CD 20 suggests B cell lineage. However, your report is not conclusive in ruling out any lymphoma. We need to wait for the final report or report from a biopsy of large tissue. You can attach the report once it comes. I hope I have answered your question. Let me know if I can assist you further. Regards.
Patient's Query
Hello doctor,
What does effacement of the lymph node mean? Based on what you have seen on the core-based path I have sent you, could this be a reactive lymph node?
Hello,
Welcome back to icliniq.com.
Effacement of lymph node architecture means disruption of its whole typical architecture. Your report is inconclusive. It might be reactive as well. In reactive conditions, also atypical cells are seen. Regards.
Patient's Query
Hello doctor,
Do CD markers stain positive for reactive lymph nodes?
Hello,
Welcome back to icliniq.com.
CD (cluster of differentiation) marker is a cluster of antigens present on the surface of leukocytes. It means cell surface molecules. So, they help in identifying cell lineage. So CD marker can be positive in a reactive cell as well. However, an expression of a specific CD molecule helps identify particular lymphoma. I hope I have answered your question. Let me know if I can assist you further. Regards.
Patient's Query
Hello doctor,
Are pax 5 or CD 30 mostly found in lymphoma cells or can they be found in benign lymphatic disease also?
Hello,
Welcome back to icliniq.com.
Following is my other opinion for your asked question. The mentioned two markers are usually positive in lymphoma, mainly the Hodgkin type. Usually, they are negative in normal, benign cells. I hope I have answered your question. Let me know if I can assist you further. Regards.
Patient's Query
Hello doctor,
The lymph node taken out for the excisional biopsy was 2 cm in diameter. It was taken from the axillary lymph node. Does the size of the lymph node excised suggest lymphoma? Regards.
Hello,
Welcome back to icliniq.com.
More than 2 cm in size usually indicates malignancy or chronic inflammation like tuberculosis. Regards.
Patient's Query
Hello doctor,
What are the features of the lymph node at 2 cm that would make you think it is malignant?
Hi,
Welcome back to icliniq.com.
Large size lymph nodes (more than 2 cm) could be due to chronic inflammation in which fibrosis might be present. Malignant ones are the ones in which there is the growth of cancer cells. So the size is increased. However, large lymph nodes for a short duration, like less than 15 days, do not conclude the same. I hope I have answered your question. Let me know if you have more question in mind. Regards.
Patient's Query
Hello doctor,
What would the microscopic appearence of cells look like for cat-stratch disease? Do they look similar to neoplastic cells?
Hi,
Welcome back to icliniq.com.
No. Cat-scratch disease is chronic inflammation condition. It is not a malignant condition. So, atypical cells are not seen in cat-scratch disease. However, there is presence of granuloma in cat-scratch disease. So it is not the case. Regards.
Patient's Query
Hello doctor,
What do dendritic cell mesh works highlighted by CD 23 mean? Would it not have the same microscopic description as mine then?
Hi,
Welcome back to icliniq.com.
Yes. it is not cat-scratch disease for sure. CD (cluster of differentiation) 23 is marker of B lymphocyte and dendritic cells. It means dendritic cells are positively stained and seen in biopsy. Dendritic cell is normally present in lymph node. No need to worry about that. I hope I have answered your questions. Regards.
Patient's Query
Hello doctor,
The microscopic section mentions that atypical cells have large vesicular nuclei and prominent nucleoli. What does that mean?
Hi,
Welcome back to icliniq.com.
It is a feature of malignant epithelial cells. Malignant cells usually have prominent nucleoli and a vesicular nucleus. So, we have to wait for the final report. I hope you understand that. Revert once the report comes. Regards.
Patient's Query
Hello doctor,
Yes, I know I need the final report. I have had breast cancer before. So I know how vital a pathology report is. How much more testing and information can a pathologist get on a complete lymph node versus a few lymph node pieces from a core biopsy? What more can I expect from the final path report?
Hi,
Welcome back to icliniq.com.
In large sections of lymph nodes, the doctor can have more tissue to examine and process for a histopathology examination. So report can be more accurate sometimes if a large excisional sample is provided. I hope this information beneficial to you. Regards.
Patient's Query
Hello doctor,
How does a pathologist decide which CD stains to use? Which CDs are used for normal lymph nodes?
Hi,
Welcome back to icliniq.com.
CD (cluster of differentiation) marker means surface molecules. In case of lymphoma suspicion, they will put lymphoma panel markers. Markers for B lymphocytes are CD 19, 20,23,79, etc., which are overexpressed in the case of B cell lymphoma. Therefore, according to the type of lymphoma, different markers are positive. In Hodgkin's lymphoma, CD 15 and 30 with pax 5 are usually positive. I hope I have answered your questions. Let me know if I can assist you further. Regards.
Patient's Query
Hello doctor,
How do you grade lymphoma if you have CD 30 and pax 5 but not CD 15? Would you expect the pathologist to test more CD on my final pathology report, or would that have been done on the core biopsy?
Hello,
Welcome back to icliniq.com.
They will do more CD (cluster of differentiation) testing including CD 15 as well I guess. Large biopsy will rule out RS (Reed Sternberg) also if present. Kindly attach your full updated report once done. I hope this will help you. Regards.
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Pathology
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