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Intermediate grade NHL
Jul 27, 2003

Dear Dr. Dezube, I have a history of Intermediate grade NHL. After chemotherapy, there was complete remission. Once again, after eight years, I have a few enlarged lymph nodes in my neck. I am in a peculiar situation wherein the opinions of two independent well known expert pathologists differed on lymph-node biopsy, one stating it to be Reactive and the other as Low-grade NHL. PETSCAN was performed and it indicated a lot of activity on the lymph nodes. I am told that the PETSCAN can only indicate that the lymph-nodes are diseased but it may not be in a position to tell whether it is malignant. Am I right? Tuberculosis has already been ruled out. I am terribly confused. I dont have any other clinical symptoms as fever, weight-loss, night-sweat etc. What do you advise? -Sinm

Response from Dr. Dezube

It's always very difficult when expert pathologists do not agree. Occasionally we send slides to a third pathologist experienced in the field of lymphoma. However, that has the potential of adding more confusion. Sometimes we do very specialized studies (called "flow cytometry") which can only be done if your surgical specimen was processed differently than routine processing. Soemtimes when all is said and done, you are still left with two differing opinions. In general, in such situations, the most prudent course of action would be to sit tight and see what happens. If you do have lymphoma, in time you will know. If you do NOT feel comfortable sitting tight without receiving treatment, you may be a candidate for rituximab therapy. Rituximab is an antibody which homes in on lymphoma cells. It typically does not have side effects and could potentially mop up any remaining lymphoma cells. However, many might feel that rituximab is a bit of an overkill in this setting. So there is just no one single answer to your question. You don't state if you are HIV positive or negative. It would be good to have this info. Good Luck. BD

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