[CIS-PAGID] Lymph Node Biopsy

[raas0027 at umn.edu]

Colleagues, 

Here is the question: say you are evaluating a patient with suspectied 
immune deficiency. If this patient were to have an excisional lymph node 
biopsy, what specific stains, flow cytometry, etc. have you found helpful 
or essential in making or supporting the diagnosis.

[The is NOT a debate about whether a biopsy is needed. Humor me. Pretend 
the patient was going to have it anyway.]

The CASE:

I have been asked to see a 45 year old gentleman for profound 
hypogammaglobulinemia. Was seen by an allergist for 5 year history 
recurrent cough/COPD. Chest CT was obtained showing perihilar and 
mediastinal LAD (some linear atelectasis, no other findings). Lymphoma 
suspected and abdomen and pelvis CT obtained: splenomegaly and several 
enlarged retroperitoneial/periaortic/pericaval lymph nodes.

Seen by oncologist for evaluation. Exam reveal no palpable LAD (e.g. 
axillary, inguinal, etc). Labs include serum electrophoresis revealing 
decreased gamma fraction. Quantitative immunoglobulins (IgG, IgM, IgA were 
undetectable). This distrubed the pathologist and oncologist so they asked 
me to see him while they continued their lymphoma work-up.

CBC showed slight lymphopenia; plateletes 130K.

Attempted a CT guided biospy of retroperitoneal lymph node. Tissue was 
insufficient for accurate interpretation.

A surgical lymph node excision is planned.

Presume this patient does NOT have lymphoma and has "CVID". Are there any 
particular requests that you would make to the pathologist who will prepare 
the biopsy specimens (e.g. stains, flow cytometry, stain for EBV, etc)? Or 
would any findings be irreleveant to diagnosis or treatment?

I'd love to hear everyone's thoughts.

Thanks!

-- 
Jason Raasch, MD

Midwest Immunology Clinic
15700 37th Ave N
Suite 110
Plymouth, MN 55446

(Phone) 763.577.0008
(FAX)   763.5770192