In early Lymphoma can blood test still be normal

[Terry8100]

I have a very hard, swollen, fixed lymph node under my ear. Its been this way for about 6 months. I finally got enough nerve to go to my PCP. His words we not very encouraging. He said with what he felt best case scenario was a "raging infection somewhere inside my body. Worse case is Lymphoma. The node is not painful and the one in the same spot on the opposite side is also hard and fixed but only fingertip sized, whereas the other is about the size of a quarter. I has a CBC done yesterday and all reading we within normal limits. My RBC was on the lowest side of normal and my WBC is 6.8. That would lead me to think we could rule out infection. I have had a low grade constant fever for approximately 3 months, intense night sweats. Sometimes I have to change clothes in the middle of the night. I am also very  fatigued all the time and we have a very busy life so I constantly have something I have to do and it takes everything I have some days just to function. I will be seeing a surgeon in 4 days, but I am very apprehensive and was just wondering if anyone has an opinion or similar experience. I am a 35yr old female and have always been in pretty good health.

[bobken]

Hello Ken,

She was tested in 2011 for thyroid and had good numbers. Her daughter has hashio moto disease which is a thyroid condition, autoimmune condition, but my sister doesn't appear to have that. MY sister is very healthy, and very active physically or was until her enlarge spleen. Always had gastrointestional issues even when we were kids, but nothing that the doctors were ever concerned over or that interfered with her daily life. Her Vitamin D level is 63.
Her B!2 is in a good range. She is quite thin but with strong muscles. She was the last person in the world anyone would think would get any type of cancer. But it is a strange world. I hope that as you suggested perhaps she might be in a miracle remission. I have been reading on the internet for other diseases that could mimic Lymphoma and the only thing I came across was Lyme disease, as sometimes one can get a enlarge spleen. But the thing is she had the energy level of a teenager. She would run up the steps two at a time. She did heavy gardening, played tennis. Even now she gets on the trend mill a few times a week and power walks a mile in 12 minutes and she doesn't break a sweat. The only thing that bothers her is when she tries to wash the floor as the bending aggravates her spleen somewhat. It would be wonderful if it wasn;t lymphoma. And if she could just shrink that spleen she could have her old active life style back. She tried to tell the doctors that when she was hanging out with some teen age boys who were showing off their new Karate moves, one accidently, as she was standing in the wrong place and he was turning at the wrong place plut a side kick right under her rib cage and up at her spleen. She screamed, we thought her ribs were broken but she said that he missed the rib and went under it as he kicked up. We iced it for a couple of hours and she was sore. About two months later she waked up with this huge sweling on her left abdomen. The doctors say there is no correlation between the enlarge spleen and the Karate side kick, but we often question it ourselves.

[bobken]

LYMPHOID POPULATION; AN ABNORMAL LYMPHOID POPULATION (35%
OF LYMPHOCYTES) IS PRESENT CHARACTERIZED AS CD5 - , CD10+ ,
CD19 ++,  CD20++ , CD23 -  AND LIGHT CHAIN RESTRICTED FOR KAPPA OF MODERATE INTENSITY. THE T- CELL POPULATION IS WITHOUT ABNORMALITY.

[Ken_PA]

Has your sister ever had thyroid problems? Or any type of autoimmune condition?

[Ken_PA]

Well, in arguing for my position that she never had lymphoma, the cytometry report could be seen as "it looks like a duck but isn't *necessarily* a duck".

Before I go further  can you zero in on this phrase:

"Lymphoid population: abnormal. (35% of Lymphocytes) 15 present characteristics as cd5, cd10+, cd19++, cd20 ++, cd23-. And light chain restricted for Kappa of moderate Intensity."

and post it exactly as in the report, with no typos.

[bobken]

Hi Ken,

Took a while to find it. I could;t upload ,so I copied the best I could.
I appreciate you explaining the terminology on the scan report.. that helped  a lot.  Belowe is what was on the flow cytometry report and the name on the report is correct

Antigen Panel Lymphoma/ lpd, mds/ panel. ( 5 color, cd45/slide scatter gating) cd2, cd3,cd4,cd5,cd7,cd8, cd10,cd11b,cd16,cd19,cd20,cd22,cd23,cd34,cd38,cd48,cd52,cd56,cd57,cd64, FMC-7 and light chain( lambda and kappa).  Antigen Density, as interpreted from fluorescence Intensity, is expressed as negative ( -, not different from isotype control). Dimly positive( +, greater than control but with significant overlap). Moderately positive(++, distance from or slightly overlapping control)  and brightly positive (+++ 1.0 -2.0 logs brighter than control. Cell viability is 99% by 7-aad stainin.

Final Diagnosis:  Monoclonal B Cell population consistent with malignant lymphoma

Lymphoid population: abnormal. (35% of Lymphocytes) 15 present characteristics as cd5, cd10+, cd19++, cd20 ++, cd23-. And light chain restricted for Kappa of moderate Intensity. The T cell population is without abnormality.

Myeloid Population: orderly maturation with normal expression of cd10, cd11b, cd16, cd64, and cd45


Monocyte population – not relatively increased with normal antigenic expression of cd4,cd11b,cd38,cd64 and cd45

Blast population is not increased nor antigenically abnormal for specimen type.

Clinical/Diagnotic Significance:
The phenotype study is indicative of B cell lymphoproliferative disorder. The co-expression cd10 is suggestive of follicle center cell origin( ie:  follicular lymphoma)
Correlation with clinical features, morphologic findings and appropriate follow up are essential

Medical indication-  malignant lymphoma.

[Ken_PA]

There is hopefully also some document you can find that describes what cell structure is seen by microscope, the "morphology" in a pathology report.