Soft tissue Density in Peritoneal

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.

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.

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.

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.

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