Lymph Node Biopsy Results: What You Need to Know

Inquiry about lymph node biopsy results?

Hello, doctor.
My grandmother (87 years old) has a swollen lymph node in the groin area (which is not painful, and there are no swollen lymph nodes in the neck or armpits).
The surgeon recommended a targeted ultrasound and a lymph node biopsy.
Later, the doctor informed us that the result was malignant lymphoma and referred us to the hematology-oncology department.
However, the oncologist later examined the groin area and felt that the lymph node was not swollen, stating that the biopsy results were not definitively abnormal.
They then arranged for an abdominal CT scan.
My grandmother does not have any discomfort (no fever, night sweats, itching, and has lost about 2-3 kg in weight over the past year).
The biopsy report shows that the immunohistochemical study indicates cytokeratin (AE1/AE3(+)), CD20(+), and PAX-5(-) immunophenotype in the necrotic tumor cells.
I do not fully understand the implications of these findings and would like to know which items indicate abnormalities.
I have researched that CD20(+) is related to B cells, but it seems that not many tests were performed.
I would like to understand what this biopsy represents and what further actions (or precautions) we should take, as this biopsy result has left the family feeling anxious.
Thank you very much.

AURORA, 20~29 year old female. Ask Date: 2019/11/25

Dr. Hu Ziren reply Oncology

It is advisable to consult your attending physician for more appropriate guidance.

Reply Date: 2019/11/25

More Info

Understanding lymph node biopsy results can be quite complex, especially when dealing with a diagnosis of potential malignancy. In your grandmother's case, the biopsy results indicated the presence of necrotic tumor cells, and the immunohistochemical study showed specific markers that can help in understanding the nature of the tumor.

Breakdown of the Results
1. Cytokeratin (AE1/AE3): This marker is typically associated with epithelial cells. The presence of cytokeratin in the necrotic tumor cells suggests that the tumor may have an epithelial origin. This is important because it helps differentiate between various types of tumors.

2. CD20: This marker is primarily expressed on B cells, which are a type of white blood cell involved in the immune response. The report indicates that CD20 is negative in the tumor cells, which suggests that the tumor may not be of B-cell origin. This is significant because it helps narrow down the type of lymphoma or other malignancies that may be present.

3. PAX-5: This is another marker associated with B-cell lineage. The negative result for PAX-5 further supports the idea that the tumor is not a B-cell lymphoma.

Interpretation of the Findings
The findings suggest that while there are necrotic tumor cells present, the specific markers tested do not indicate a typical B-cell lymphoma. The absence of CD20 and PAX-5 suggests that the tumor may not be a lymphoma at all, or if it is, it may be of a different lineage than what is commonly seen in B-cell lymphomas.

Next Steps and Recommendations
Given the complexity of your grandmother's case, here are some recommendations:
1. Consultation with a Hematologist/Oncologist: Since the initial diagnosis indicated a malignant lymphoma, it is crucial to have a thorough evaluation by a specialist in hematology or oncology. They can provide a more comprehensive interpretation of the biopsy results and recommend further testing if necessary.

2. Imaging Studies: The abdominal CT scan that has been arranged will help assess whether there are any other areas of concern in the body. This is important for staging the disease and determining the best course of action.

3. Monitoring Symptoms: While your grandmother currently has no significant symptoms, it is essential to monitor for any changes, such as unexplained weight loss, fever, night sweats, or any new lumps. These could indicate progression of disease and should be reported to her healthcare provider.

4. Further Testing: Depending on the findings from the CT scan and the hematologist's recommendations, additional tests such as a PET scan or more specific blood tests may be warranted to provide a clearer picture of her health status.

5. Emotional Support: It is understandable that this situation can cause anxiety for the family. Consider seeking support from counseling services or support groups for families dealing with cancer diagnoses.

Conclusion
In summary, while the biopsy results indicate the presence of necrotic tumor cells, the specific immunohistochemical markers suggest that it may not be a typical B-cell lymphoma. It is essential to follow up with a specialist for further evaluation and to discuss the next steps in management. Keeping an open line of communication with her healthcare team will be vital in navigating this challenging situation.

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