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Non Hodgkin's Lymphoma Test Report

Hello,
i hope i would get some help from this forum
my cousin who is 33 old has Chronicle Hep C , he tried some kind of interferon+something treatment which made
his health very weak and he had to stop the treatment after that he is not well he gets fever very often and feel very
weak sometime he feel very hard to breath, cough etc...
so he went to Dr and had this test called Non Hodgkin's Lymphoma
below is the report if somebody can explain me the report i would really appreciate that i have read a little bit about
NHL on this forum and would be reading more ... (NOTE: he had 2 tests because once it was not preserved properly that is what the Dr says)
here is the detailed report:

*******************First report******************************:

CLINICAL DETAILS: Diagnosed as Non-Hodgkin's lymphoma. Bone marrow slides received for second opinion.  
PERIPHERAL BLOOD COUNTS:
HB:              13.6 G/DL
HCT:             38.6 %
MCV:             91.9 FL
MCH:             32.4 PG
WBC'S:           2.7 x 10E9/L
ANC:             0.5 x 10E9/L
PLATELETS:       157 x 10E9/L

CORRECTED RETICULOCYTES COUNT: Not suitable for reporting.
RESULTS OF DIRECT COMB TEST: Negative.

PERIPHERAL BLOOD FILM: Shows anisocytosis and poikilocytosis. There is leukopenia with neutropenia. Platelets are normal on film.

BONE MARROW ASPIRATE: Dilute marrow showing predominantly [34800.00]atypical lymphoid cells. Myeloid precursors seen. No apparent [37200.00]erythroid precursor or megakaryocytes noted. No [28800.00]non-haematopoietic cell or haemoparasites seen.

BONE TREPHINE TOUCH PREP: Hypocellular smear showing [31800.00]predominantly atypical lymphoid cells.

RESULT OF BONE TREPHINE (H&E) SECTION: Good length specimen [36000.00]showing poorly preserved material. However, overall cellularity [38400.00]is around 75 to 80%. Cellular areas show presence of multiple [37200.00]lymphoid aggregates. Normal haematopoiesis is appreciated [34800.00]comprising of erythroid and myeloiod precursors. Megakaryocyt

RESULT OF BONE TREPHINE (H&E) SECTION: Good length specimen [36000.00]showing poorly preserved material. However, overall cellularity [38400.00]is around 75 to 80%. Cellular areas show presence of multiple [37200.00]lymphoid aggregates. Normal haematopoiesis is appreciated [34800.00]comprising of erythroid and myeloiod precursors. Megakaryocyt

TDT: Negative. [9000.00]RESULTS OF RETICULIN STAINS: Not suitable for reporting.

OPINION: Not diagnostic. Bone marrow is dilute while bone trephine is a poorly preserved specimen. Biopsy of accessible lymph node is recommended for further evaluation.Suggest cellular bone marrow with a good length bone trephine if clinically indicated, which will be processed free of charge on

the same HN number.[11400.00]Note: This case has also been reviewed by our consultant [34200.00]histopathologist, Professor Dr. Shahid Pervez and he concurs [36600.00]with the opinion.

************************************Seond Report*******************************************************:

PERIPHERAL BLOOD COUNTS:
HB:             13.6 G/DL
HCT:            35.3 %
MCV:            90.1 FL
MCH:            34.7 PG
WBC'S:           2.3 x 10E9/L
ANC:             0.2 x 10E9/L
PLATELETS:       126 x 10E9/L

PERIPHERAL BLOOD FILM: Reveals normocytic and normochromic red blood cells. Red blood cell agglutination seen. There is neutropenia and leukopenia. There is lymphocytosis with 20% atypical lymphocytes seen. Platelets are low on film.

RESULTS OF DIRECT COOMB'S TEST: 2+ positive.

BONE MARROW ASPIRATE: Hypocellular specimen showing predominantly lymphoid cells comprising of 55% of the total non erythroid nucleated cell population. These lymphoid cells are small to medium in size with high nuclear to cytoplasmic ratio, clumped chromatin and scanty agranular cytoplasm.Few of these

lymphoid cells show cleaving of nuclei. Myeloid and erythroid precursors noted. M:E ratio is 3:1. Occasional megakaryocytes seen. Blast cells are less than 5%. Plasma cells are less than 3%. No non-haematopoietic cells, clumps or haemoparasite identified.

BONE TREPHINE TOUCH PREP: Not suitable for reporting.

RESULT OF BONE TREPHINE (H&E) SECTION: Small length specimen showing effaced architecture and hypercellularity for age. Overall, cellularity is around 85-90%. Cellular areas show infiltration with lymphoid cells. Residual haematopoiesis is markedly suppressed. Occasional megakaryocytes seen.

RESULTS OF IMMUNOHISTOCHEMISTR:
CD20:Negative
CD5: Positive
CD3: Positive
Tdt: Negative

OPINION: Findings are consistent with T-lymphocytosis which may be reactive. Possibility of mature T-cell lymphoproliferative disorder can not be excluded on the material examined. Suggest biopsy of any accessible lymph node.
10 Responses
1081992 tn?1389907237
COMMUNITY LEADER
Hi, when blood counts are low it is possible that the bone marrow (where blood cells are manufactured) has been infiltrated with unusual cells. The unusual cells crowd out the production of the normal blood cells. The unusual cells might be cancer.

The "RESULT OF BONE TREPHINE (H&E) SECTION" does say that is happening.

But you'd want to mainly look at the Opinion section.

"T-lymphocytosis" means there is an elevated number of the immune cells called T-lymphocytes. The term "reactive" means the condition when they proliferate as part of their normal job - which is to kill infected cells but also cancer cells.

"Possibility of mature T-cell lymphoproliferative disorder can not be excluded on the material examined" means it might be cancer - a "T-cell lymphoma".

"Suggest biopsy of any accessible lymph node" is to see if there is T-cell lymphoma in some lymph node which would be easy go remove surgically. Then they look at the cells to see if anything looks like cancerous cells.

I wonder why they haven't dome a PET scan at this point, to  try and identify any possible cancerous nodes in the body.
Avatar universal
Just to add my cousin's white blood cells are less don't know the reason but he has less than half of normal white blood cells i think he has between 1900 to 2500 somthing .
Avatar universal
AnyBody ?
Avatar universal
??? :(
Avatar universal
Thanks very much for the reply i really appreciate that .
so it means there are not sure if this is cancer or something else? there are chances?
what is PET scan?
1081992 tn?1389907237
COMMUNITY LEADER
correct, they are not sure. I don't think that percentages can be estimated at this point. There are also some lymphoproliferative disorders that are not cancer, but they are rare AFAIK.

In a PET scan, a person gets injected with some radioactive sugar. That sugar accumulates in cancer cells and so those areas can be see with a certain type scanner. It's way to quickly see suspect areas bodywide, because those ares "light up" in the scan. It would enable them to easily choose which node to biopsy.

The PET scan uses anti-matter.

Then again, a biopsy would likely be cheaper than the PET.
1081992 tn?1389907237
COMMUNITY LEADER
but a PET can also detect areas of infection... and I suppose it's possible that the whole problem really results from something like a virus infection. Or an adult T-cell leukemia?

I don''t really know, this type of thing is all very complicated.

I suppose the best thing is to think the best until further testing is done.
Avatar universal
Thanks very very much for the reply i really appreciate that lets wait for the other results
Thanks.
Avatar universal
Can people live with NHL??
1081992 tn?1389907237
COMMUNITY LEADER
Yes, and it depends a lot on the type. For instance, Follicular NHL is often 'indolent' meaning that it's slow growing. Some types respond well to therapy.
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