I had an open cervical lymph node biopsy performed about two months ago. They developed suddenly and became quite large over three months. I additionally have lost 35% body weight in a year. I feel incredibly fatigued, unable to eat, developed an enlarged spleen and even showed a sharp drop in my blood counts. The surgeon, who performed the biopsy, indicated that the pathology report was normal. But, after learning that he caused debilitating damage to my spinal accessory nerve, I would like to get a second opinion of the report. Here is what it says. Diagnosis: Skeletal muscle, fibroconnective and fibroadipose tissue with somewhat effaced, but lymphoid tissue with extensive crush artifact. Note: Impacted foreign material is also identified. The process appears to be reactive in nature; however extensive crush artifact is present thereby limiting interpretation. Please correlate with clinical findings. Was there an antecedent procedure at the site? Gross description - Specimen consists of two irregular fragments of tan tissue measuring 1.2 x 1.0 x 0.5 and 1.0 x 0.4 x 0.3. The largest piece has white sutures attached, which are removed. The specimen is entirely submitted in one cassette. The surgeon assured me two months ago that everything looked great and allowed me to read the report. Can you clarify the terms effaced lymphoid tissue, impacted foreign material and irregular fragments? Also, in what condition they are commonly seen? What process appears to be reactive in nature? Does the gross description indicate two pieces of lymphoid tissue or two complete lymph nodes? I was told that he removed four complete nodes. Should he have submitted all four? The measurements do not indicate which unit of measurement was used, but do the numbers seem normal? Is there any reason for sutures have been attached to the largest piece of tissue? Please explain.
Based on your query, my opinion is as follows. When the nodes are small, during biopsy due to holding by forceps to remove the nodes, crush artifacts are known to occur. Larger nodes are much easier to remove without crush artifacts, whereas in smaller nodes, it can occur. To be more precise, it can occur more in normal, because abnormal lymph nodes are usually firm to hard. Normal nodes are known to be soft in nature and more commonly crush artifacts can be found, if the node is small. Effaced lymphoid tissue means the structure of a lymph node is a bit altered. Reactive means, more lymphoid follicles are present, indicating the lymph node response to infection. Impacted foreign material, here the suture is the foreign material. Sometimes to identify nodes or tissues, it is common to suture the tissue. As multiple nodes were removed, to identify the initial node, it is often tagged. As no pathology was found, it has no significance. Sometimes, the nodes will be small and stick to each other during processing. Hence, instead of four nodes, they might have found two larger nodes. The measurement is usually in centimeters, means it is very small. Irregular fragments, means the tissue while removing, as they are soft in nature, loose the nodular shape. Hence, they are termed irregular fragments. Based on the size and part of tissue showing reactive nature, I would not suspect anything wrong in the pathology report. If the nodes were larger or at present if you have any large and hard nodes, then further evaluation will be necessary.
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