Soft tissue Density in Peritoneal

PeprmntPat55

Good evening.

Said I wasn’t gonna do it yet her I am. In Aug my Onco ordered CT scan of abdomen & chest due to me being symptomatic -night sweats started in April & now low grade fevers nightly along with fatigue. Have been in remission from FNHL stage 3b since 12/2016. Did 8 rounds of Rituxan for maintenance.

the CT scan showed an 18.2 mm soft tissue density in the peritonium. Onco said to W & W since so small, everything else looked good.

my follow up CT scan is 12/21. The closer it gets I get panicked. Has anyone had relapse in this area of the body?

thanks, Pat

Max Former Hodgkins Stage 3

Wow, Peppermint -- it's been a long time !

I relapsed in 2022 after about ten years clean, and in several areas, one of which was around the base of the abdominal cavity, so I guess that counts. But, also in both auxiliaries and outboard of the upper spleen. Relapse of lymphoma can occur almost anywhere I suppose. I'm glad the suspect tissue mass is smallish and in only one location. Please follow up with us,

max

po18guy

Different world, but I have relapsed in small intestine and spleen. One day we may know how this seemingly random choice of relapse areas occurs.

PeprmntPat55

Max and Po thank you for your responses. Yes it’s been while. Remission has been good.

CT scan showed multiple lymph node enlargement. Saw Onco yesterday. Nodes are still pretty small but I’m still having drenching night sweats, low grade fevers and no appetite. Onco suggests PET scan then likely a CT guided biopsy. He said if it is the same ( follicular ) he wants to treat with Obinutuzumab, one infusion a week for 4 weeks then reevaluate. No chemo at this time.

I feel good with this plan. Hope everyone had a great Christmas!

po18guy

Pat, it sounds like the nodes are rather deep. In any case, one (or more) must come out, especially with the symptoms. At my second or third relapse (we'll never know), they were all in so deep that my hematologist joked that I would have to go home and grow some tumors closer to the surface. So, following doctor's orders, I did. The good news is that there are new drugs and combos that did not exist when you began this journey. And, it appears to remain indolent. LEt us know how it goes!

And yes, a fine small family Christmas - that years back was never expected to arrive.

PeprmntPat55

https://csn.cancer.org/discussion/comment/1711759#Comment_1711759

There is one small node in my groin. That’s the one he thought he could do a CT guided biopsy? But that’s not removal right? Must the entire node come out?

po18guy

https://csn.cancer.org/discussion/comment/1711765#Comment_1711765

For the best, most reliable pathology, yes. Since they are small and since you have hundreds of them, loss of one is not an issue. The nodes must be examined, not only for malignant lymphocytes they may carry, but also for the condition of the internal architecture, or structure of the node. By way of analogy, think of lymph nodes as oranges, with skin, segments, seeds and stem. Now imagine sectioning one to examine its contents and finding only clay inside - all the rest gone. That is a rough idea of what the pathologist is searching for.

A node which is enlarged from reacting to infection simply appears as a large node when examined - "reactive" in nature. If the internal architecture has been effaced, it is a clear sign that malignant lymphocytes have taken it over. As well, if only a needle sample is drawn from the node, it might be taken from a section of the node which does not contain any malignant lymphocytes. There are false negatives using that method. An entire node, probably the size of a green pea or small red bean gives are far more reliable pathological result.

Max Former Hodgkins Stage 3

https://csn.cancer.org/discussion/comment/1711765#Comment_1711765

Peppermint,

Over the last three years, I have had numerous biopsies, including one via 'interventional radiology.' An aspirational form, ultrasound-guided. The biopsy gained from that led my docs in the WRONG direction. I later had an excise (cut out) biopsy which clarified what I really had. I would never have an aspirational biopsy regarding lymphoma or leukemia again (they may be ok for other cancers).

max

ItsVeryCalm

Pat, I was sorry to hear that you’re having a recurrence. I read your post just about the time I received my diagnosis (follicular lymphoma, low grade, early stage) and until today haven't posted here. I don't know whether you've had your biopsy or not — if so, I hope it went well. But given the variety in the nature of people's experiences you're receiving, and some similarities, in location at least, between your current situation and mine, I thought I'd share. My lymphoma is retroperitoneal, and in a location that my local major university hospital indicated was inaccessible by needle biopsy (aortocaval, just beneath the renal vessels). I went to MDA for a second opinion, and they indicated that it would be challenging, but their more senior IR docs thought it was possible. They were able to perform a CT-guided needle biopsy (core and aspirate) from a single node, from which adequate material was available to confirm a follicular lymphoma diagnosis. So, while excisional biopsy is desirable, as it allows for more comprehensive analysis, it may not always be absolutely necessary, depending on what information is being sought. I hope you'll let us know how you're doing.

PeprmntPat55

Thanks to all who commented, I so appreciate it. I will keep everything in mind.

I have a new Onco, same practice but requested a change as previous Onco was not responsive in my requests for discussion of PET results. I found out that since several Oncos retired the last few years (mine incuded) Wellspan hired intermediate/temporary Oncos. I couldn't believe it!

I now have an Onco who has been with the practice for awhile and I had even seen him before. But I am rambling. Here is the long and short of it:

PET scan results Deauville score of 3 so we are doing another scan in April. I am relieved and although my symptoms are aggravating as all get out, I was not looking forward to treatment again.

So at this time, I am thankful and maybe, just maybe, these nodes will resolve themselves!

Hopeful.

Pat

ItsVeryCalm

https://csn.cancer.org/discussion/comment/1712331#Comment_1712331

I’m relieved for you, and glad to hear you have a doctor you’re comfortable with. Thank you for the update!