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Forum Name: Lymphoma

Question: Negative biopsy with ALL Lymphoma symptoms


 ourhouse93 - Wed Sep 21, 2005 5:39 pm

I have a 34 year old brother-in-law who presents ALL the symptoms of Lymphoma. i.e.: weight loss, night sweats, swollen glands in neck, head and jaw, profound fatigue, itching, loss of appetite, foul taste in mouth, burning in the gut, elevated SGPT, jaundice and enlarged spleen. He has recently begun to complain with "kidney and gall bladder pain". He also has a couple of symptoms that may prove erroneous. His hair has cycles of falling out in patches and he says his perspiration has developed an odor that is quite pungent. The paradox is this; a lymph node biopsy that has yielded a negative result. Can this be a false negative? This is my husband's brother. Their Father (my father-in-law) passed last year from recurrent Hodgkin's after chemo and a stem cell transplant. Needless to say we are more than a bit concerned. Thank you for your consideration to this post.
 Theresa Jones, RN - Thu Sep 29, 2005 4:05 am

User avatar Hi ourhouse93,
Has there been any mention of a repeat biopsy or diagnostic studies? If there has not been then I would very strongly suggest that this be completed.
Sincerely,
Rntdj
 ourhouse93 - Fri Sep 30, 2005 10:43 am

Hello Rntdj, UPDATE...the site of his biopsy has become red and enlarged to a size more than pre-biopsy (excise site infection) ??? The only new test (as we understand it) is he will be screened for Hepatitis. We are very puzzled why this has not already taken place. He has been sick for nearly 2 years with the fatigue and hair loss issues. The other symptoms have appeared in the last several months and his current physician (who is the 2nd or 3rd consulted) has had him on antibiotics for the past 5 weeks. We are completely baffled. However some family members say his color has improved. It seems that his liver counts fluctuate and this seems to determine his sense of well being. Is it possible that we are over-reacting and that his illness is a lymphatic infection? In addition to losing my father-in-law last July I also lost my sister to OVCA. in March of 2004. I just don't think our family can cope with much more...Thank you so much for your time. I will echo your advice to our family 1700 hundred miles away. Feeling quite helpless...
 Theresa Jones, RN - Sat Oct 01, 2005 10:10 am

User avatar Hi ourhouse93,
There are different types of Lymphoma. For example, some of the signs and symptoms of Hodgkin's Lymphoma are painless enlarged lymph nodes, weight loss, night sweats, poor appetite, generalized itching, fatigue, hair loss, enlarged spleen, etc. Again, I would inquire about an additional lymph node biopsy, bone marrow biopsy, CT Scan of the neck, chest, abdomen and pelvis. You stated that he has been being treated for an infection of the biopsy site? 5 weeks of antibiotic therapy? Was a culture sent of the wound to identify any resistent organisms? If this has not been completed then this would be another suggestion because 5 weeks of antibiotic treatment in my opinion suggests an infection of a resistent organism, for example, MRSA (Methicillin-Resistant Staphylococcus Aureus). I would hope that Hepatits screens and HIV testing would have previously been completed to rule these illnesses out. I do not feel you are over-reacting by any means. I hope that when your time permits you will post a follow up.
Sincerely,
Rntdj
 ourhouse93 - Sun Oct 02, 2005 2:59 pm

Dear Rntdj,
I should clarify. The 5 week anti-biotic treatment has been for "an infection" believed to be causing the myriad of symptoms. The swollen, red, excise site is merely an addition to the already fragile health of "Dan". The biopsy, I am sad to say only came about after several family demands. Please be aware, (as if symptoms were not enough) this physician is fully aware of the death of the patient's Father to Hodgkin's. The 5 week (approaching 6 week) treatment began with an in town doc. We all insisted this was too complex of an issue for a simple Lymphatic infection. " Dan" agreed to seek a second opinion which led him 2 hours away to his current doctor. This physician ordered an X-ray and CT of the abdomen. These tests highlighted the presence of a "spot" on his lung and an enlarged spleen. The only change in treatment was an alternate anti-biotic. His lung seemed to be a no concern...what?, and his spleen enlargement reduced to a "mistake" by the physician. We are now to believe the spleen was "NEVER" enlarged ! As to HIV testing and Hepatitis screening, you and I are both puzzled. I have been making suggestions along with my sister-in-laws for many weeks now. It is only in the past week that the physician has indicated that he would consider a Hepatitis screen. It is any man's (or woman's) guess as to if this or HIV testing will actually occur. I'm afraid the identity of my young brother-in-law's illness will be revealed post mortem. Again your advice is greatly appreciated.
 Dr. Tamer Fouad - Fri Oct 07, 2005 12:38 am

User avatar ourhouse93!
Pathology is the most important diagnostic test in lymphoma. Luckily, it is quite accurate. One possibility for false negative results is if the lymph node tissue is not adequate (not likely if this is an excisional biopsy in which the whole of the lymph node is removed) or if the surgeon picked a less significant lymph node (again not very likely). This would depend on the size and appearance of these lymph nodes in relation to others.
Usually a lymph node of the neck is first assessed with a fine needle biopsy.
Once the pathologist has the specimen, determining if it contains lymphoma is usually not difficult. A panel of special stains (immunohistochemistry) will allow him to conclude the nature of this disease.
If that is not enough in some cases of lymphoma the diagnosis can be made at a genetic level.
What exactly does the biopsy report say (other than negative for malignancy)?
Whether the spleen is enlarged or not is unclear and it does not appear to show 'focal lesions' which are common in lymphomas involving the spleen.
I am assuming his blood counts (white blood cells) are normal since you didn't mention them.
I understand your concern but until we exclude lymphoma for the time being it seems that the main concern here is indeed the rising liver enzymes and the bilirubin. A hepatitis screen is mandatory and should be done as soon as possible.
One thing to keep in mind is the size and number of the lymph nodes if they are increasing in size and number that should be a reason for concern. In such a case I would advise you to consult with a hemato-oncologist.
Best regards,

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