Which doctor treats non-Hodgkin lymphoma? Oncologist or Hematologist?

Posted by babu123 @babu123, May 19 8:06am

Which doctor should receive treatment for non-Hodgkin lymphoma? oncologist or hematologist?

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@babu123

Let me tell you a bit about the past — I had a little swelling on my face near the left ear for the past two years, there was no pain, but from last month it started swelling under the throat, so I went to the ENT specialist. Before the operation, the ENT surgeon said that it was a lymph node tumor. After the operation, I found out that it was not a tumor, but lymphoma. Soft tissue, left parotid samples were sent to 2 laboratories for biopsy and the reports were different, 2 samples were immunohistrochemstry and the reports were also different, one showed B cell non-Hodgkin lymphoma, the other one showed follicular lymphoma, I have added two reports earlier. Last week I went to the hematologist, he said that after analyzing my physical symptoms, he thought it could not be B cell non-Hodgkin lymphoma, so he asked to send the sample to a neighboring country for review and advised me to take PET scan and treatment until the report comes. But I am afraid that I will get the right treatment?

Jump to this post

@babu123 I certainly understand your uncertainty. It’s not as though it’s six of one or a half dozen of the other. The appropriate treatment can’t be determined without a definitive diagnosis. What are your other symptoms?
https://www.mayoclinic.org/diseases-conditions/non-hodgkins-lymphoma/symptoms-causes/syc-20375680

REPLY
@pmm

@babu123 I certainly understand your uncertainty. It’s not as though it’s six of one or a half dozen of the other. The appropriate treatment can’t be determined without a definitive diagnosis. What are your other symptoms?
https://www.mayoclinic.org/diseases-conditions/non-hodgkins-lymphoma/symptoms-causes/syc-20375680

Jump to this post

I had no symptoms other than swelling around my ears and throat. But after the operation, there is a lot of acidity problem, burning and pain in the chest and stomach. I didn't understand why the doctor called the surgery for a tumor when my report was lymphoma. I asked him but he did not give any real answer. Samples have been sent to neighboring countries for testing. If the report there is B cell type lymphoma. Chemotherapy will be given for this in our country. Well after chemotherapy will I be fine??

REPLY

Brief Clinical History: Non Hodgkin's Lymphoma.
Operation (01.05.2024): Left superficial parotidectomy.
Histopathology (06.05. 2024): Chronic sialadenitis.
Lymph node: Non Hodgkin's lymphoma.
Immunohistochemistry (12.05.2024): CD20, CD3, CD10: positive, BCL6, BCL2, CyclinD1,
CD2: negative, ki67: positive, suggestive of follicular lymphoma, grade III.
Immunohistochemistry (16.05.2024): Favor diffuse large B cell lymphoma, activated B cell
type.
Radiotherapy : Not applied.
Chemotherapy : Not applied.
Blood Sugar: 5.28 mmol/L.
S. Creatinine: 61 mmol/L
Procedure: Whole body FDG PET scan was acquired from vertex to mid thigh in a whole-body PET-CT scanner (128 Slice GE Discovery VCT), one hour after intravenous injection 9.59 mCi (355-MBq) of 8F-FDG. High resolution contrast CT scan was also obtained of the same area. Oral contrast was administered for bowel pacification over 90 min. before the scan.
VUE point HD algorithm and slices were reformatted into transaxial, coronal and sagittal views.
Semi-quantitative estimation of FDG uptake was performed by calculating SUVmax value, corrected for dose administered and body weight (g/ml).
Summary of the Findings
Brain:
Visualized part of cerebral and cerebellar hemispheres are uniform with normal physiological tracer distribution in the brain parenchyma. The ventricular system appears to be normal in in the brain.
diameter and no mass lesion or midline shifting. No focal lesion or abnormal FDG uptake noted
where clinically indicated.
Note: All brain metastases may not be apparent on a PET/CT sean and a MRI can be performed

Evidence of left superficial parotidectomy, no significant focal or diffuse FDG uptake at the site of surgery
Normal physiologic uptake noted in the nasopharynx, oropharynx, hypopharynx and larynx.
Parotid and submandibular glands demonstrate normal metabolic activity.
Thyroid gland: mildly enlarged & shows homogenous pattern on CT, no abnormal
FDG uptake is seen in the thyroid.
No significant cervical and supraclavicular lymphadenopathy is noted
No abnormal FDG uptake in the head and neck region.
Thorax: (Mediastinal mean SUV: 1)
Both lung fields: showing normal attenuation. The mediastinal vascular structures are well opacified with I/V contrast. The trachea and main bronchi appear normal. No parenchymal focal or diffuse lesion could be detected.
Multiple prominent subcarinal, aortopulmonary & left bronchopulmonary lymph nodes with mild FDG uptake (SUVmax: 5.8), largest one 10 mm in SA dia)
No pleural thickening or effusion is seen.
Axillary lymph nodes are not enlarged.
No other abnormal FDG uptake noted in the lung parenchyma, mediastinum or Axillary region.
Breasts: no soft tissue mass or abnormal tracer uptake in either breast region.
Heart: normal in position and all cardiac chambers appear normal, no pericardial effusion.
Normal physiological FDG uptake in the myocardium.
Great vessels are normal in size & relation, no abnormal tracer uptake in its wall.
Abdomen and pelvis: (Hepatic mean SUV: 1.2)
Liver: Mildly enlarged (15.5 cm along its CC span) and uniform parenchymal density. No focal area of altered attenuation or abnormal enhancement is noted. Vascular structures are normally visualized and distributed normally. No abnormal uptake of FDG is noted in the liver parenchyma. The intrahepatic biliary radicles are not dilated.
Gall bladder: normal in size & shape with normal wall thickness.
No calculus or soft tissue
mass within the lumen, no pericholecystic collection; no abnormal FDG uptake.
Pancreas: Paripancreatic fat planes are preserved. No evidence of cyst, calcification, diffuse or focal parenchymal lesion could be detected. No abnormal FDG uptake in the pancreas.

Spleen: mildly enlarged (11 cm along its long axis) with uniform parenchyma. No focal or diffuse lesion is noted, splenic hilar vessels are not significantly dilated; no abnormal FDG uptake.
Adrenal glands: appear normal in size, shape & position with normal attenuation pattern on CT.
No abnormal FDG uptake is noted.
Kidneys: appear normal in position and attenuation pattern, relatively larger (RK: 11 cm & LK: 11.5 cm in its bipolar length). No scan evidence of calculus, any mass lesion, cyst or hydronephrosis is noted. Physiological tracer distribution in both kidneys & ureters.
Urinary bladder: well distended and normal wall thickness, no calculus or intravesical mass is noted, no abnormal FDG uptake.
Prostate gland: moderately enlarged (52x40mm) & uniform parenchymal density, no abnormal tracer uptake.
Stomach wall is mildly thick (15 mm) & mild diffuse FDG uptake (SUVmax: 4.2).
Opacified small bowel and large bowel loops appear normal in caliber and fold pattern; no remarkable wall thickening or intraluminal mass lesion could be detected, no other abnormal FDG uptake throughout the intestine.
Seminal vesicles: appear normal. Genitalia: unremarkable.
Peritoneum & Mesentery: appears normal in pre and post contrast CT scan, no abnormally dilated mesenteric vasculature. No abnormal tracer concentration in the peritoneum.
No enlarged lymph nodes (with or without FDG avid) are noted at the region of porta hepatis, pancreatic, paraaortic, celio-mesenteric, parailiac, pelvic and inguinal regions.
Great Vessels: Aorta and IVC appears to be normal in diameter and clear lumen; no abnormal tracer uptake in its wall.
Musculoskeletal system:
The visalized portion of the musculoskeletal system shows normal physiological tracer distribution.
No focal abnormal uptake of FDG anywhere else.

REPLY
@babu123

Brief Clinical History: Non Hodgkin's Lymphoma.
Operation (01.05.2024): Left superficial parotidectomy.
Histopathology (06.05. 2024): Chronic sialadenitis.
Lymph node: Non Hodgkin's lymphoma.
Immunohistochemistry (12.05.2024): CD20, CD3, CD10: positive, BCL6, BCL2, CyclinD1,
CD2: negative, ki67: positive, suggestive of follicular lymphoma, grade III.
Immunohistochemistry (16.05.2024): Favor diffuse large B cell lymphoma, activated B cell
type.
Radiotherapy : Not applied.
Chemotherapy : Not applied.
Blood Sugar: 5.28 mmol/L.
S. Creatinine: 61 mmol/L
Procedure: Whole body FDG PET scan was acquired from vertex to mid thigh in a whole-body PET-CT scanner (128 Slice GE Discovery VCT), one hour after intravenous injection 9.59 mCi (355-MBq) of 8F-FDG. High resolution contrast CT scan was also obtained of the same area. Oral contrast was administered for bowel pacification over 90 min. before the scan.
VUE point HD algorithm and slices were reformatted into transaxial, coronal and sagittal views.
Semi-quantitative estimation of FDG uptake was performed by calculating SUVmax value, corrected for dose administered and body weight (g/ml).
Summary of the Findings
Brain:
Visualized part of cerebral and cerebellar hemispheres are uniform with normal physiological tracer distribution in the brain parenchyma. The ventricular system appears to be normal in in the brain.
diameter and no mass lesion or midline shifting. No focal lesion or abnormal FDG uptake noted
where clinically indicated.
Note: All brain metastases may not be apparent on a PET/CT sean and a MRI can be performed

Evidence of left superficial parotidectomy, no significant focal or diffuse FDG uptake at the site of surgery
Normal physiologic uptake noted in the nasopharynx, oropharynx, hypopharynx and larynx.
Parotid and submandibular glands demonstrate normal metabolic activity.
Thyroid gland: mildly enlarged & shows homogenous pattern on CT, no abnormal
FDG uptake is seen in the thyroid.
No significant cervical and supraclavicular lymphadenopathy is noted
No abnormal FDG uptake in the head and neck region.
Thorax: (Mediastinal mean SUV: 1)
Both lung fields: showing normal attenuation. The mediastinal vascular structures are well opacified with I/V contrast. The trachea and main bronchi appear normal. No parenchymal focal or diffuse lesion could be detected.
Multiple prominent subcarinal, aortopulmonary & left bronchopulmonary lymph nodes with mild FDG uptake (SUVmax: 5.8), largest one 10 mm in SA dia)
No pleural thickening or effusion is seen.
Axillary lymph nodes are not enlarged.
No other abnormal FDG uptake noted in the lung parenchyma, mediastinum or Axillary region.
Breasts: no soft tissue mass or abnormal tracer uptake in either breast region.
Heart: normal in position and all cardiac chambers appear normal, no pericardial effusion.
Normal physiological FDG uptake in the myocardium.
Great vessels are normal in size & relation, no abnormal tracer uptake in its wall.
Abdomen and pelvis: (Hepatic mean SUV: 1.2)
Liver: Mildly enlarged (15.5 cm along its CC span) and uniform parenchymal density. No focal area of altered attenuation or abnormal enhancement is noted. Vascular structures are normally visualized and distributed normally. No abnormal uptake of FDG is noted in the liver parenchyma. The intrahepatic biliary radicles are not dilated.
Gall bladder: normal in size & shape with normal wall thickness.
No calculus or soft tissue
mass within the lumen, no pericholecystic collection; no abnormal FDG uptake.
Pancreas: Paripancreatic fat planes are preserved. No evidence of cyst, calcification, diffuse or focal parenchymal lesion could be detected. No abnormal FDG uptake in the pancreas.

Spleen: mildly enlarged (11 cm along its long axis) with uniform parenchyma. No focal or diffuse lesion is noted, splenic hilar vessels are not significantly dilated; no abnormal FDG uptake.
Adrenal glands: appear normal in size, shape & position with normal attenuation pattern on CT.
No abnormal FDG uptake is noted.
Kidneys: appear normal in position and attenuation pattern, relatively larger (RK: 11 cm & LK: 11.5 cm in its bipolar length). No scan evidence of calculus, any mass lesion, cyst or hydronephrosis is noted. Physiological tracer distribution in both kidneys & ureters.
Urinary bladder: well distended and normal wall thickness, no calculus or intravesical mass is noted, no abnormal FDG uptake.
Prostate gland: moderately enlarged (52x40mm) & uniform parenchymal density, no abnormal tracer uptake.
Stomach wall is mildly thick (15 mm) & mild diffuse FDG uptake (SUVmax: 4.2).
Opacified small bowel and large bowel loops appear normal in caliber and fold pattern; no remarkable wall thickening or intraluminal mass lesion could be detected, no other abnormal FDG uptake throughout the intestine.
Seminal vesicles: appear normal. Genitalia: unremarkable.
Peritoneum & Mesentery: appears normal in pre and post contrast CT scan, no abnormally dilated mesenteric vasculature. No abnormal tracer concentration in the peritoneum.
No enlarged lymph nodes (with or without FDG avid) are noted at the region of porta hepatis, pancreatic, paraaortic, celio-mesenteric, parailiac, pelvic and inguinal regions.
Great Vessels: Aorta and IVC appears to be normal in diameter and clear lumen; no abnormal tracer uptake in its wall.
Musculoskeletal system:
The visalized portion of the musculoskeletal system shows normal physiological tracer distribution.
No focal abnormal uptake of FDG anywhere else.

Jump to this post

@babu123 Welcome to Mayo Clinic Connect. Unfortunately, we are not medical doctors on this forum. We are fellow patients and family members sharing our stories and experiences with different health issues. We are not able, nor will we, interpret scans.

Do you have specific concerns for your doctor to address? When will you see your provider to have them explain the results to you? What conditions have you already been apprised of?
Ginger

REPLY
@babu123

Brief Clinical History: Non Hodgkin's Lymphoma.
Operation (01.05.2024): Left superficial parotidectomy.
Histopathology (06.05. 2024): Chronic sialadenitis.
Lymph node: Non Hodgkin's lymphoma.
Immunohistochemistry (12.05.2024): CD20, CD3, CD10: positive, BCL6, BCL2, CyclinD1,
CD2: negative, ki67: positive, suggestive of follicular lymphoma, grade III.
Immunohistochemistry (16.05.2024): Favor diffuse large B cell lymphoma, activated B cell
type.
Radiotherapy : Not applied.
Chemotherapy : Not applied.
Blood Sugar: 5.28 mmol/L.
S. Creatinine: 61 mmol/L
Procedure: Whole body FDG PET scan was acquired from vertex to mid thigh in a whole-body PET-CT scanner (128 Slice GE Discovery VCT), one hour after intravenous injection 9.59 mCi (355-MBq) of 8F-FDG. High resolution contrast CT scan was also obtained of the same area. Oral contrast was administered for bowel pacification over 90 min. before the scan.
VUE point HD algorithm and slices were reformatted into transaxial, coronal and sagittal views.
Semi-quantitative estimation of FDG uptake was performed by calculating SUVmax value, corrected for dose administered and body weight (g/ml).
Summary of the Findings
Brain:
Visualized part of cerebral and cerebellar hemispheres are uniform with normal physiological tracer distribution in the brain parenchyma. The ventricular system appears to be normal in in the brain.
diameter and no mass lesion or midline shifting. No focal lesion or abnormal FDG uptake noted
where clinically indicated.
Note: All brain metastases may not be apparent on a PET/CT sean and a MRI can be performed

Evidence of left superficial parotidectomy, no significant focal or diffuse FDG uptake at the site of surgery
Normal physiologic uptake noted in the nasopharynx, oropharynx, hypopharynx and larynx.
Parotid and submandibular glands demonstrate normal metabolic activity.
Thyroid gland: mildly enlarged & shows homogenous pattern on CT, no abnormal
FDG uptake is seen in the thyroid.
No significant cervical and supraclavicular lymphadenopathy is noted
No abnormal FDG uptake in the head and neck region.
Thorax: (Mediastinal mean SUV: 1)
Both lung fields: showing normal attenuation. The mediastinal vascular structures are well opacified with I/V contrast. The trachea and main bronchi appear normal. No parenchymal focal or diffuse lesion could be detected.
Multiple prominent subcarinal, aortopulmonary & left bronchopulmonary lymph nodes with mild FDG uptake (SUVmax: 5.8), largest one 10 mm in SA dia)
No pleural thickening or effusion is seen.
Axillary lymph nodes are not enlarged.
No other abnormal FDG uptake noted in the lung parenchyma, mediastinum or Axillary region.
Breasts: no soft tissue mass or abnormal tracer uptake in either breast region.
Heart: normal in position and all cardiac chambers appear normal, no pericardial effusion.
Normal physiological FDG uptake in the myocardium.
Great vessels are normal in size & relation, no abnormal tracer uptake in its wall.
Abdomen and pelvis: (Hepatic mean SUV: 1.2)
Liver: Mildly enlarged (15.5 cm along its CC span) and uniform parenchymal density. No focal area of altered attenuation or abnormal enhancement is noted. Vascular structures are normally visualized and distributed normally. No abnormal uptake of FDG is noted in the liver parenchyma. The intrahepatic biliary radicles are not dilated.
Gall bladder: normal in size & shape with normal wall thickness.
No calculus or soft tissue
mass within the lumen, no pericholecystic collection; no abnormal FDG uptake.
Pancreas: Paripancreatic fat planes are preserved. No evidence of cyst, calcification, diffuse or focal parenchymal lesion could be detected. No abnormal FDG uptake in the pancreas.

Spleen: mildly enlarged (11 cm along its long axis) with uniform parenchyma. No focal or diffuse lesion is noted, splenic hilar vessels are not significantly dilated; no abnormal FDG uptake.
Adrenal glands: appear normal in size, shape & position with normal attenuation pattern on CT.
No abnormal FDG uptake is noted.
Kidneys: appear normal in position and attenuation pattern, relatively larger (RK: 11 cm & LK: 11.5 cm in its bipolar length). No scan evidence of calculus, any mass lesion, cyst or hydronephrosis is noted. Physiological tracer distribution in both kidneys & ureters.
Urinary bladder: well distended and normal wall thickness, no calculus or intravesical mass is noted, no abnormal FDG uptake.
Prostate gland: moderately enlarged (52x40mm) & uniform parenchymal density, no abnormal tracer uptake.
Stomach wall is mildly thick (15 mm) & mild diffuse FDG uptake (SUVmax: 4.2).
Opacified small bowel and large bowel loops appear normal in caliber and fold pattern; no remarkable wall thickening or intraluminal mass lesion could be detected, no other abnormal FDG uptake throughout the intestine.
Seminal vesicles: appear normal. Genitalia: unremarkable.
Peritoneum & Mesentery: appears normal in pre and post contrast CT scan, no abnormally dilated mesenteric vasculature. No abnormal tracer concentration in the peritoneum.
No enlarged lymph nodes (with or without FDG avid) are noted at the region of porta hepatis, pancreatic, paraaortic, celio-mesenteric, parailiac, pelvic and inguinal regions.
Great Vessels: Aorta and IVC appears to be normal in diameter and clear lumen; no abnormal tracer uptake in its wall.
Musculoskeletal system:
The visalized portion of the musculoskeletal system shows normal physiological tracer distribution.
No focal abnormal uptake of FDG anywhere else.

Jump to this post

@babu123
Hello again. As I recall, the last time we spoke you were feeling like you were getting conflicting information from your doctors and your test results were being sent out of the country for a second opinion. How did that work out? Are these results new?
Ginger is absolutely correct. This forum is intended to provide support for patients based on the experience of our members. We are not medical professionals, so we are unable to assist you in diagnosis based on medical reports.
We do understand and relate to the anxiety we all feel when we don’t get good information except to know that something is wrong.
Did you ever get any information back from your medical records that were sent out of country? What does your doctor say about these results?

REPLY
@babu123

Brief Clinical History: Non Hodgkin's Lymphoma.
Operation (01.05.2024): Left superficial parotidectomy.
Histopathology (06.05. 2024): Chronic sialadenitis.
Lymph node: Non Hodgkin's lymphoma.
Immunohistochemistry (12.05.2024): CD20, CD3, CD10: positive, BCL6, BCL2, CyclinD1,
CD2: negative, ki67: positive, suggestive of follicular lymphoma, grade III.
Immunohistochemistry (16.05.2024): Favor diffuse large B cell lymphoma, activated B cell
type.
Radiotherapy : Not applied.
Chemotherapy : Not applied.
Blood Sugar: 5.28 mmol/L.
S. Creatinine: 61 mmol/L
Procedure: Whole body FDG PET scan was acquired from vertex to mid thigh in a whole-body PET-CT scanner (128 Slice GE Discovery VCT), one hour after intravenous injection 9.59 mCi (355-MBq) of 8F-FDG. High resolution contrast CT scan was also obtained of the same area. Oral contrast was administered for bowel pacification over 90 min. before the scan.
VUE point HD algorithm and slices were reformatted into transaxial, coronal and sagittal views.
Semi-quantitative estimation of FDG uptake was performed by calculating SUVmax value, corrected for dose administered and body weight (g/ml).
Summary of the Findings
Brain:
Visualized part of cerebral and cerebellar hemispheres are uniform with normal physiological tracer distribution in the brain parenchyma. The ventricular system appears to be normal in in the brain.
diameter and no mass lesion or midline shifting. No focal lesion or abnormal FDG uptake noted
where clinically indicated.
Note: All brain metastases may not be apparent on a PET/CT sean and a MRI can be performed

Evidence of left superficial parotidectomy, no significant focal or diffuse FDG uptake at the site of surgery
Normal physiologic uptake noted in the nasopharynx, oropharynx, hypopharynx and larynx.
Parotid and submandibular glands demonstrate normal metabolic activity.
Thyroid gland: mildly enlarged & shows homogenous pattern on CT, no abnormal
FDG uptake is seen in the thyroid.
No significant cervical and supraclavicular lymphadenopathy is noted
No abnormal FDG uptake in the head and neck region.
Thorax: (Mediastinal mean SUV: 1)
Both lung fields: showing normal attenuation. The mediastinal vascular structures are well opacified with I/V contrast. The trachea and main bronchi appear normal. No parenchymal focal or diffuse lesion could be detected.
Multiple prominent subcarinal, aortopulmonary & left bronchopulmonary lymph nodes with mild FDG uptake (SUVmax: 5.8), largest one 10 mm in SA dia)
No pleural thickening or effusion is seen.
Axillary lymph nodes are not enlarged.
No other abnormal FDG uptake noted in the lung parenchyma, mediastinum or Axillary region.
Breasts: no soft tissue mass or abnormal tracer uptake in either breast region.
Heart: normal in position and all cardiac chambers appear normal, no pericardial effusion.
Normal physiological FDG uptake in the myocardium.
Great vessels are normal in size & relation, no abnormal tracer uptake in its wall.
Abdomen and pelvis: (Hepatic mean SUV: 1.2)
Liver: Mildly enlarged (15.5 cm along its CC span) and uniform parenchymal density. No focal area of altered attenuation or abnormal enhancement is noted. Vascular structures are normally visualized and distributed normally. No abnormal uptake of FDG is noted in the liver parenchyma. The intrahepatic biliary radicles are not dilated.
Gall bladder: normal in size & shape with normal wall thickness.
No calculus or soft tissue
mass within the lumen, no pericholecystic collection; no abnormal FDG uptake.
Pancreas: Paripancreatic fat planes are preserved. No evidence of cyst, calcification, diffuse or focal parenchymal lesion could be detected. No abnormal FDG uptake in the pancreas.

Spleen: mildly enlarged (11 cm along its long axis) with uniform parenchyma. No focal or diffuse lesion is noted, splenic hilar vessels are not significantly dilated; no abnormal FDG uptake.
Adrenal glands: appear normal in size, shape & position with normal attenuation pattern on CT.
No abnormal FDG uptake is noted.
Kidneys: appear normal in position and attenuation pattern, relatively larger (RK: 11 cm & LK: 11.5 cm in its bipolar length). No scan evidence of calculus, any mass lesion, cyst or hydronephrosis is noted. Physiological tracer distribution in both kidneys & ureters.
Urinary bladder: well distended and normal wall thickness, no calculus or intravesical mass is noted, no abnormal FDG uptake.
Prostate gland: moderately enlarged (52x40mm) & uniform parenchymal density, no abnormal tracer uptake.
Stomach wall is mildly thick (15 mm) & mild diffuse FDG uptake (SUVmax: 4.2).
Opacified small bowel and large bowel loops appear normal in caliber and fold pattern; no remarkable wall thickening or intraluminal mass lesion could be detected, no other abnormal FDG uptake throughout the intestine.
Seminal vesicles: appear normal. Genitalia: unremarkable.
Peritoneum & Mesentery: appears normal in pre and post contrast CT scan, no abnormally dilated mesenteric vasculature. No abnormal tracer concentration in the peritoneum.
No enlarged lymph nodes (with or without FDG avid) are noted at the region of porta hepatis, pancreatic, paraaortic, celio-mesenteric, parailiac, pelvic and inguinal regions.
Great Vessels: Aorta and IVC appears to be normal in diameter and clear lumen; no abnormal tracer uptake in its wall.
Musculoskeletal system:
The visalized portion of the musculoskeletal system shows normal physiological tracer distribution.
No focal abnormal uptake of FDG anywhere else.

Jump to this post

Thank you! Yes, reports from outside my country have also arrived. There it says B cell non Hodgkin lymphoma. (

TEST NAME
dualCORE Unlimited Markers
SPECIMEN INFORMATION
Received one paraffin block labeled with 242-2696 A1 for immunohistochemistry-
CLINICAL HISTORY
Suggestive of Non Hodgkin's lymphoma, intermediate grade (on 06-05-2024).
METHODOLOGY
Immunohistochemistry
FINAL DIAGNOSIS
Left parotid region swelling, excision biopsy, paraffin block for review and immunohistochemistry:
• High grade B cell Non Hodgkin's lymphoma, see comment
COMMENT
Differential diagnosis considered are 1. Burkitt lymphoma 2. Diffuse Large B cell lymphoma
BCI2, BCI6, CMYC gene rearrangement studies are recommended as per NCCN guidelines cmyc and CD30 IHC report will follow as an addendum
Clinicoradiological correlation is recommended.
FIC & IMMUNOHISTOCHEVTGRANTERPREN
Shows effaced nodal architecture and replacement by sheets of medium to large sized atypical cells with fine chromatin, inconspicuous nucleolus and scant cytoplas)
At this time we have done the PET scan, the report of which I posted yesterday. Today one has a consultant with what he says has infected lunch and liver and reached the third stage. Meanwhile, after eating something, I am vomiting and my stomach is hurting. I was admitted to the hospital yesterday due to vomiting and pain. Today the doctor came and decided chemotherapy. I am afraid that the doctor of our country is doing a lot of wrong treatment intentionally, telling the patient everything and charging treatment charges at will which is beyond the affordability of many people.

REPLY
@babu123

Brief Clinical History: Non Hodgkin's Lymphoma.
Operation (01.05.2024): Left superficial parotidectomy.
Histopathology (06.05. 2024): Chronic sialadenitis.
Lymph node: Non Hodgkin's lymphoma.
Immunohistochemistry (12.05.2024): CD20, CD3, CD10: positive, BCL6, BCL2, CyclinD1,
CD2: negative, ki67: positive, suggestive of follicular lymphoma, grade III.
Immunohistochemistry (16.05.2024): Favor diffuse large B cell lymphoma, activated B cell
type.
Radiotherapy : Not applied.
Chemotherapy : Not applied.
Blood Sugar: 5.28 mmol/L.
S. Creatinine: 61 mmol/L
Procedure: Whole body FDG PET scan was acquired from vertex to mid thigh in a whole-body PET-CT scanner (128 Slice GE Discovery VCT), one hour after intravenous injection 9.59 mCi (355-MBq) of 8F-FDG. High resolution contrast CT scan was also obtained of the same area. Oral contrast was administered for bowel pacification over 90 min. before the scan.
VUE point HD algorithm and slices were reformatted into transaxial, coronal and sagittal views.
Semi-quantitative estimation of FDG uptake was performed by calculating SUVmax value, corrected for dose administered and body weight (g/ml).
Summary of the Findings
Brain:
Visualized part of cerebral and cerebellar hemispheres are uniform with normal physiological tracer distribution in the brain parenchyma. The ventricular system appears to be normal in in the brain.
diameter and no mass lesion or midline shifting. No focal lesion or abnormal FDG uptake noted
where clinically indicated.
Note: All brain metastases may not be apparent on a PET/CT sean and a MRI can be performed

Evidence of left superficial parotidectomy, no significant focal or diffuse FDG uptake at the site of surgery
Normal physiologic uptake noted in the nasopharynx, oropharynx, hypopharynx and larynx.
Parotid and submandibular glands demonstrate normal metabolic activity.
Thyroid gland: mildly enlarged & shows homogenous pattern on CT, no abnormal
FDG uptake is seen in the thyroid.
No significant cervical and supraclavicular lymphadenopathy is noted
No abnormal FDG uptake in the head and neck region.
Thorax: (Mediastinal mean SUV: 1)
Both lung fields: showing normal attenuation. The mediastinal vascular structures are well opacified with I/V contrast. The trachea and main bronchi appear normal. No parenchymal focal or diffuse lesion could be detected.
Multiple prominent subcarinal, aortopulmonary & left bronchopulmonary lymph nodes with mild FDG uptake (SUVmax: 5.8), largest one 10 mm in SA dia)
No pleural thickening or effusion is seen.
Axillary lymph nodes are not enlarged.
No other abnormal FDG uptake noted in the lung parenchyma, mediastinum or Axillary region.
Breasts: no soft tissue mass or abnormal tracer uptake in either breast region.
Heart: normal in position and all cardiac chambers appear normal, no pericardial effusion.
Normal physiological FDG uptake in the myocardium.
Great vessels are normal in size & relation, no abnormal tracer uptake in its wall.
Abdomen and pelvis: (Hepatic mean SUV: 1.2)
Liver: Mildly enlarged (15.5 cm along its CC span) and uniform parenchymal density. No focal area of altered attenuation or abnormal enhancement is noted. Vascular structures are normally visualized and distributed normally. No abnormal uptake of FDG is noted in the liver parenchyma. The intrahepatic biliary radicles are not dilated.
Gall bladder: normal in size & shape with normal wall thickness.
No calculus or soft tissue
mass within the lumen, no pericholecystic collection; no abnormal FDG uptake.
Pancreas: Paripancreatic fat planes are preserved. No evidence of cyst, calcification, diffuse or focal parenchymal lesion could be detected. No abnormal FDG uptake in the pancreas.

Spleen: mildly enlarged (11 cm along its long axis) with uniform parenchyma. No focal or diffuse lesion is noted, splenic hilar vessels are not significantly dilated; no abnormal FDG uptake.
Adrenal glands: appear normal in size, shape & position with normal attenuation pattern on CT.
No abnormal FDG uptake is noted.
Kidneys: appear normal in position and attenuation pattern, relatively larger (RK: 11 cm & LK: 11.5 cm in its bipolar length). No scan evidence of calculus, any mass lesion, cyst or hydronephrosis is noted. Physiological tracer distribution in both kidneys & ureters.
Urinary bladder: well distended and normal wall thickness, no calculus or intravesical mass is noted, no abnormal FDG uptake.
Prostate gland: moderately enlarged (52x40mm) & uniform parenchymal density, no abnormal tracer uptake.
Stomach wall is mildly thick (15 mm) & mild diffuse FDG uptake (SUVmax: 4.2).
Opacified small bowel and large bowel loops appear normal in caliber and fold pattern; no remarkable wall thickening or intraluminal mass lesion could be detected, no other abnormal FDG uptake throughout the intestine.
Seminal vesicles: appear normal. Genitalia: unremarkable.
Peritoneum & Mesentery: appears normal in pre and post contrast CT scan, no abnormally dilated mesenteric vasculature. No abnormal tracer concentration in the peritoneum.
No enlarged lymph nodes (with or without FDG avid) are noted at the region of porta hepatis, pancreatic, paraaortic, celio-mesenteric, parailiac, pelvic and inguinal regions.
Great Vessels: Aorta and IVC appears to be normal in diameter and clear lumen; no abnormal tracer uptake in its wall.
Musculoskeletal system:
The visalized portion of the musculoskeletal system shows normal physiological tracer distribution.
No focal abnormal uptake of FDG anywhere else.

Jump to this post

I’m so sorry to hear that you are feeling so poorly.
https://my.clevelandclinic.org/health/diseases/22777-burkitt-lymphoma
https://www.cancer.gov/news-events/press-releases/2020/burkitt-lymphoma-adult
Chemotherapy sometimes has harsh side effects. Hopefully they can give you anti nausea medication to mitigate that.
I wish that there was some way to reassure you and confirm that you are, in fact, getting the correct diagnosis and treatment. This must be frightening and frustrating for you. That is outside of the scope of this forum.
I’d encourage you to ask lots of questions about what the treatment process entails. What benefits does the chemotherapy provide? What can you expect for side effects and what can be done to make you comfortable? Is this chemotherapy the best possible treatment approach?
Healthcare should be affordable for everyone in this world.
Please let me know how you are doing and how your questions have been answered.

REPLY
@babu123

Brief Clinical History: Non Hodgkin's Lymphoma.
Operation (01.05.2024): Left superficial parotidectomy.
Histopathology (06.05. 2024): Chronic sialadenitis.
Lymph node: Non Hodgkin's lymphoma.
Immunohistochemistry (12.05.2024): CD20, CD3, CD10: positive, BCL6, BCL2, CyclinD1,
CD2: negative, ki67: positive, suggestive of follicular lymphoma, grade III.
Immunohistochemistry (16.05.2024): Favor diffuse large B cell lymphoma, activated B cell
type.
Radiotherapy : Not applied.
Chemotherapy : Not applied.
Blood Sugar: 5.28 mmol/L.
S. Creatinine: 61 mmol/L
Procedure: Whole body FDG PET scan was acquired from vertex to mid thigh in a whole-body PET-CT scanner (128 Slice GE Discovery VCT), one hour after intravenous injection 9.59 mCi (355-MBq) of 8F-FDG. High resolution contrast CT scan was also obtained of the same area. Oral contrast was administered for bowel pacification over 90 min. before the scan.
VUE point HD algorithm and slices were reformatted into transaxial, coronal and sagittal views.
Semi-quantitative estimation of FDG uptake was performed by calculating SUVmax value, corrected for dose administered and body weight (g/ml).
Summary of the Findings
Brain:
Visualized part of cerebral and cerebellar hemispheres are uniform with normal physiological tracer distribution in the brain parenchyma. The ventricular system appears to be normal in in the brain.
diameter and no mass lesion or midline shifting. No focal lesion or abnormal FDG uptake noted
where clinically indicated.
Note: All brain metastases may not be apparent on a PET/CT sean and a MRI can be performed

Evidence of left superficial parotidectomy, no significant focal or diffuse FDG uptake at the site of surgery
Normal physiologic uptake noted in the nasopharynx, oropharynx, hypopharynx and larynx.
Parotid and submandibular glands demonstrate normal metabolic activity.
Thyroid gland: mildly enlarged & shows homogenous pattern on CT, no abnormal
FDG uptake is seen in the thyroid.
No significant cervical and supraclavicular lymphadenopathy is noted
No abnormal FDG uptake in the head and neck region.
Thorax: (Mediastinal mean SUV: 1)
Both lung fields: showing normal attenuation. The mediastinal vascular structures are well opacified with I/V contrast. The trachea and main bronchi appear normal. No parenchymal focal or diffuse lesion could be detected.
Multiple prominent subcarinal, aortopulmonary & left bronchopulmonary lymph nodes with mild FDG uptake (SUVmax: 5.8), largest one 10 mm in SA dia)
No pleural thickening or effusion is seen.
Axillary lymph nodes are not enlarged.
No other abnormal FDG uptake noted in the lung parenchyma, mediastinum or Axillary region.
Breasts: no soft tissue mass or abnormal tracer uptake in either breast region.
Heart: normal in position and all cardiac chambers appear normal, no pericardial effusion.
Normal physiological FDG uptake in the myocardium.
Great vessels are normal in size & relation, no abnormal tracer uptake in its wall.
Abdomen and pelvis: (Hepatic mean SUV: 1.2)
Liver: Mildly enlarged (15.5 cm along its CC span) and uniform parenchymal density. No focal area of altered attenuation or abnormal enhancement is noted. Vascular structures are normally visualized and distributed normally. No abnormal uptake of FDG is noted in the liver parenchyma. The intrahepatic biliary radicles are not dilated.
Gall bladder: normal in size & shape with normal wall thickness.
No calculus or soft tissue
mass within the lumen, no pericholecystic collection; no abnormal FDG uptake.
Pancreas: Paripancreatic fat planes are preserved. No evidence of cyst, calcification, diffuse or focal parenchymal lesion could be detected. No abnormal FDG uptake in the pancreas.

Spleen: mildly enlarged (11 cm along its long axis) with uniform parenchyma. No focal or diffuse lesion is noted, splenic hilar vessels are not significantly dilated; no abnormal FDG uptake.
Adrenal glands: appear normal in size, shape & position with normal attenuation pattern on CT.
No abnormal FDG uptake is noted.
Kidneys: appear normal in position and attenuation pattern, relatively larger (RK: 11 cm & LK: 11.5 cm in its bipolar length). No scan evidence of calculus, any mass lesion, cyst or hydronephrosis is noted. Physiological tracer distribution in both kidneys & ureters.
Urinary bladder: well distended and normal wall thickness, no calculus or intravesical mass is noted, no abnormal FDG uptake.
Prostate gland: moderately enlarged (52x40mm) & uniform parenchymal density, no abnormal tracer uptake.
Stomach wall is mildly thick (15 mm) & mild diffuse FDG uptake (SUVmax: 4.2).
Opacified small bowel and large bowel loops appear normal in caliber and fold pattern; no remarkable wall thickening or intraluminal mass lesion could be detected, no other abnormal FDG uptake throughout the intestine.
Seminal vesicles: appear normal. Genitalia: unremarkable.
Peritoneum & Mesentery: appears normal in pre and post contrast CT scan, no abnormally dilated mesenteric vasculature. No abnormal tracer concentration in the peritoneum.
No enlarged lymph nodes (with or without FDG avid) are noted at the region of porta hepatis, pancreatic, paraaortic, celio-mesenteric, parailiac, pelvic and inguinal regions.
Great Vessels: Aorta and IVC appears to be normal in diameter and clear lumen; no abnormal tracer uptake in its wall.
Musculoskeletal system:
The visalized portion of the musculoskeletal system shows normal physiological tracer distribution.
No focal abnormal uptake of FDG anywhere else.

Jump to this post

My treatment has started from today. Chemo-immunotherapy is going on from 6 am and will last for 48 hours. So far I have been fine and have not experienced any problems.

REPLY
@babu123

My treatment has started from today. Chemo-immunotherapy is going on from 6 am and will last for 48 hours. So far I have been fine and have not experienced any problems.

Jump to this post

Hi @babu123. Are you in a clinic for the full 48 hours? Is your chemo-immunotherapy given by IV?

REPLY
@babu123

Brief Clinical History: Non Hodgkin's Lymphoma.
Operation (01.05.2024): Left superficial parotidectomy.
Histopathology (06.05. 2024): Chronic sialadenitis.
Lymph node: Non Hodgkin's lymphoma.
Immunohistochemistry (12.05.2024): CD20, CD3, CD10: positive, BCL6, BCL2, CyclinD1,
CD2: negative, ki67: positive, suggestive of follicular lymphoma, grade III.
Immunohistochemistry (16.05.2024): Favor diffuse large B cell lymphoma, activated B cell
type.
Radiotherapy : Not applied.
Chemotherapy : Not applied.
Blood Sugar: 5.28 mmol/L.
S. Creatinine: 61 mmol/L
Procedure: Whole body FDG PET scan was acquired from vertex to mid thigh in a whole-body PET-CT scanner (128 Slice GE Discovery VCT), one hour after intravenous injection 9.59 mCi (355-MBq) of 8F-FDG. High resolution contrast CT scan was also obtained of the same area. Oral contrast was administered for bowel pacification over 90 min. before the scan.
VUE point HD algorithm and slices were reformatted into transaxial, coronal and sagittal views.
Semi-quantitative estimation of FDG uptake was performed by calculating SUVmax value, corrected for dose administered and body weight (g/ml).
Summary of the Findings
Brain:
Visualized part of cerebral and cerebellar hemispheres are uniform with normal physiological tracer distribution in the brain parenchyma. The ventricular system appears to be normal in in the brain.
diameter and no mass lesion or midline shifting. No focal lesion or abnormal FDG uptake noted
where clinically indicated.
Note: All brain metastases may not be apparent on a PET/CT sean and a MRI can be performed

Evidence of left superficial parotidectomy, no significant focal or diffuse FDG uptake at the site of surgery
Normal physiologic uptake noted in the nasopharynx, oropharynx, hypopharynx and larynx.
Parotid and submandibular glands demonstrate normal metabolic activity.
Thyroid gland: mildly enlarged & shows homogenous pattern on CT, no abnormal
FDG uptake is seen in the thyroid.
No significant cervical and supraclavicular lymphadenopathy is noted
No abnormal FDG uptake in the head and neck region.
Thorax: (Mediastinal mean SUV: 1)
Both lung fields: showing normal attenuation. The mediastinal vascular structures are well opacified with I/V contrast. The trachea and main bronchi appear normal. No parenchymal focal or diffuse lesion could be detected.
Multiple prominent subcarinal, aortopulmonary & left bronchopulmonary lymph nodes with mild FDG uptake (SUVmax: 5.8), largest one 10 mm in SA dia)
No pleural thickening or effusion is seen.
Axillary lymph nodes are not enlarged.
No other abnormal FDG uptake noted in the lung parenchyma, mediastinum or Axillary region.
Breasts: no soft tissue mass or abnormal tracer uptake in either breast region.
Heart: normal in position and all cardiac chambers appear normal, no pericardial effusion.
Normal physiological FDG uptake in the myocardium.
Great vessels are normal in size & relation, no abnormal tracer uptake in its wall.
Abdomen and pelvis: (Hepatic mean SUV: 1.2)
Liver: Mildly enlarged (15.5 cm along its CC span) and uniform parenchymal density. No focal area of altered attenuation or abnormal enhancement is noted. Vascular structures are normally visualized and distributed normally. No abnormal uptake of FDG is noted in the liver parenchyma. The intrahepatic biliary radicles are not dilated.
Gall bladder: normal in size & shape with normal wall thickness.
No calculus or soft tissue
mass within the lumen, no pericholecystic collection; no abnormal FDG uptake.
Pancreas: Paripancreatic fat planes are preserved. No evidence of cyst, calcification, diffuse or focal parenchymal lesion could be detected. No abnormal FDG uptake in the pancreas.

Spleen: mildly enlarged (11 cm along its long axis) with uniform parenchyma. No focal or diffuse lesion is noted, splenic hilar vessels are not significantly dilated; no abnormal FDG uptake.
Adrenal glands: appear normal in size, shape & position with normal attenuation pattern on CT.
No abnormal FDG uptake is noted.
Kidneys: appear normal in position and attenuation pattern, relatively larger (RK: 11 cm & LK: 11.5 cm in its bipolar length). No scan evidence of calculus, any mass lesion, cyst or hydronephrosis is noted. Physiological tracer distribution in both kidneys & ureters.
Urinary bladder: well distended and normal wall thickness, no calculus or intravesical mass is noted, no abnormal FDG uptake.
Prostate gland: moderately enlarged (52x40mm) & uniform parenchymal density, no abnormal tracer uptake.
Stomach wall is mildly thick (15 mm) & mild diffuse FDG uptake (SUVmax: 4.2).
Opacified small bowel and large bowel loops appear normal in caliber and fold pattern; no remarkable wall thickening or intraluminal mass lesion could be detected, no other abnormal FDG uptake throughout the intestine.
Seminal vesicles: appear normal. Genitalia: unremarkable.
Peritoneum & Mesentery: appears normal in pre and post contrast CT scan, no abnormally dilated mesenteric vasculature. No abnormal tracer concentration in the peritoneum.
No enlarged lymph nodes (with or without FDG avid) are noted at the region of porta hepatis, pancreatic, paraaortic, celio-mesenteric, parailiac, pelvic and inguinal regions.
Great Vessels: Aorta and IVC appears to be normal in diameter and clear lumen; no abnormal tracer uptake in its wall.
Musculoskeletal system:
The visalized portion of the musculoskeletal system shows normal physiological tracer distribution.
No focal abnormal uptake of FDG anywhere else.

Jump to this post

Actually I faced some problems before chemotherapy such as vomiting and abdominal pain, that's why I was admitted to the clinic two days ago. I will stay in the clinic for 5 days in total, during which my fish test report will come and the next decision will be taken by the doctors.
Ja it’s given by IV

REPLY
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