[CIS-PAGID] Lymph Node Biopsy

[Dewton Vasconcelos]

Hi Jason, good afternoon

It is really important to rule out lymphomas and leukemias for 
hypogammaglobulinemic patients, so a biopsy of the lymphnodes is 
fundamental. Fine needle punctures biopsies are usually confounding.
It is also important to rule out possible infectious diseases (EBV, CMV, 
mycobacterial and fungal diseases etc.) and even adverse drug reactions, 
such as those associated to anticonvulsants (mainly hidantoinates and 
carbamazepine), sometimes associated to lymphadenomegaly and 
hypogammaglobulinemia and even severe lymphopenia. Other drugs such as 
sulfasalazine, D-penicillamine, gold salts, glucocorticoids etc.
On the other hand CVID with sarcoid features are not uncommon.

All the best,

Dewton

raas0027 at umn.edu wrote:

> 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!

>

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