[CIS-PAGID] Lymph Node Biopsy

[Cunningham-Rundles, Charlotte]

 Hi Jason,


We order:

Aside from routine pathology, immunopathology and flow to include

For T cells: CD3, CD4 and CD8
For B cells: CD19 or CD20 and Kappa, Lambda,
CD5, CD10 and other markers for leukemia lymphoma
NK CD56 or other
Plasma cells:  CD38, 138

We save for FROZEN TISSUE as well. Tell them to not put all
the tissue into formalin in the OR/ Put some in wet gauze.

I am becoming really negative on fine needle bx of nodes in PID. Seems like
they always have to be removed as the path is not clear. So I am pretty much
done with this.

Charlotte Cunningham-Rundles, MD, PhD
Departments of Medicine and Pediatrics
The David S Gottesman Professor
The Immunology Institute
Mount Sinai School of Medicine
1425 Madison Avenue
New York, NY 10029
Phone: 212 659 9268
Fax: 212 987 5593
Email: Charlotte.Cunningham-Rundles at mssm.edu





> From: <raas0027 at umn.edu>

> Reply-To: PAGID <pagid at list.clinimmsoc.org>

> Date: Wed, 22 Feb 2012 10:32:45 -0600

> To: PAGID <pagid at list.clinimmsoc.org>

> Subject: [CIS-PAGID] Lymph Node Biopsy

> 

> 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