Tibetan Terrier with generalised lymphadenopathy

RE: Tibetan Terrier with generalised lymphadenopathy

nikki — Fri, 13 Nov 2015 21:16:28 GMT

I do most of my FNA's without suction, just stick a green needle in and out a few times. Get a high level of confirmed diiagnoses with this technique and cytologists often comment on high cellularity of slides and the cells being well preserved. I only try suction if nothing comes out with the needle technique.

RE: Tibetan Terrier with generalised lymphadenopathy

Rob Loxley — Fri, 13 Nov 2015 18:59:03 GMT

[quote user="Hannah Wynne Richards"]What's PARR when it's at home?[/quote]

http://ctdslab.co.uk/services/cytology/parr-pcr-for-antigen-receptor-rearrangement/

RE: Tibetan Terrier with generalised lymphadenopathy

Hannah Wynne Richards — Thu, 12 Nov 2015 17:54:15 GMT

I was wondering how you magiced the cells out!

What's PARR when it's at home?

Wynne

RE: Tibetan Terrier with generalised lymphadenopathy

Gerry Polton — Thu, 12 Nov 2015 17:34:08 GMT

Only if it's positive. If it's negative it's more money spent and a question mark still remains over whether lymph node removal is indicated.

Gerry

RE: Tibetan Terrier with generalised lymphadenopathy

Rob Loxley — Thu, 12 Nov 2015 17:30:48 GMT

Would PARR cloanilty testing be worth considering on the sytology sample?

We found that another problem with lymph node FNA results were previous cytologists who would always sit on the fence...

RE: Tibetan Terrier with generalised lymphadenopathy

Gerry Polton — Thu, 12 Nov 2015 17:18:53 GMT

I should have said, this no suction aspiration (thanks Wynne) technique is optimal for suspected lymphoma only. If you try it on most other lesions you will get little or nothing. Sorry, I should have been clearer.

Gerry

RE: Tibetan Terrier with generalised lymphadenopathy

Hannah Wynne Richards — Thu, 12 Nov 2015 17:08:39 GMT

I too was wondering how you can aspirate without sucking!

Wynne

RE: Tibetan Terrier with generalised lymphadenopathy

Martin Atkinson — Thu, 12 Nov 2015 17:05:40 GMT

[quote user="Gerry Polton"]For those of you who find that FNA is consistently non-diagnostic, you are probably either applying too much suction when you aspirate (none is almost too much; some is too much) [/quote]There are clearly some things some of us can do competently that others can't and vice-versa. My recent graduate always says I suck too hard (no smutty remarks please)! and should almost literally just push the needle in rotating gently as I go then withdraw, but if I don't suck I get nothing.

RE: Tibetan Terrier with generalised lymphadenopathy

Gerry Polton — Thu, 12 Nov 2015 15:32:59 GMT

I think you are going to need a whole lymph node biopsy. When cost is a limiting factor you sometimes have to do this sooner as you have to go for the test which is most likely to provide something unequivocal (eg unequivocally not lymphoma - I do understand that this doesn't necessarily get you nearer to the non-neoplastic diagnosis).

For what it's worth, I would always do FNA first, like you did. For those of you who find that FNA is consistently non-diagnostic, you are probably either applying too much suction when you aspirate (none is almost too much; some is too much) or you are applying too much pressure when you spread the cells (weight of single slide is almost too much pressure; any downward force is definitely too much).

Gerry

RE: Tibetan Terrier with generalised lymphadenopathy

Anthony Dennison — Thu, 12 Nov 2015 15:28:37 GMT

I should probably add back in May she had pancreatitis, with odd partial seizures that seemed to be controlled with prednisolone. After 8 weeks of a tapering dose she was fine. A mild non-regenerative anaemia was noted back then, and it still is present now (HCT 25%)

RE: Tibetan Terrier with generalised lymphadenopathy

Anthony Dennison — Thu, 12 Nov 2015 15:22:36 GMT

Globulins 52.

RE: Tibetan Terrier with generalised lymphadenopathy

Andrew Kent — Thu, 12 Nov 2015 15:13:36 GMT

Hi Anthony,

SPE is serum protein electrophoresis, useful to see if a high protein is monoclonal (which can fit with malignancy though not always) or polyclonal (more likely to indicate an inflammatory response).

How high are the globs? It might be useful to see the blood results if possible.

As the pathologist asks - any history of travel? The ocular and nasal signs could fit with leishmania for example.

Ideally I would look at LN histology here because it sounds odd and I don't think neoplastic disease can be completely excluded otherwise.

Andy

RE: Tibetan Terrier with generalised lymphadenopathy

Martin Atkinson — Thu, 12 Nov 2015 15:10:18 GMT

SPE = specific protein electropheresis - looks at different globulin fractions that determine if its likely to be inflammatory or neoplastic. But once again this is lymphoma until proved otherwise.

I don't bother with FNAs these days they often come back equivocal so I go for full node biopsy (popliteal if involved sub- mandibular often too reactive and non-diagnostic) unless there are over-riding reasons against.

Coincidentally I've just seen a 10 year old Dobie with generalised lymphadenopathy. IME its nailed on lymphoma but the owners can't afford much investigation let alone chemo so I've offered an FNA with the caveat that it may well prove non-diagnostic.