我因頸部硬塊,病理切片後診斷為Favor Hodgkin

發問日期	2015年12月14日
問題內容	我因頸部硬塊,病理切片後診斷為Favor Hodgkin lymphoma,但對診斷(病理報告如下)及後續治療方式有疑問請協助 1.依以下報告是否即可確定為Hodgkin lymphoma,(病理報告中有些腫瘤標記並不確定)並據以展開治療 2.若為Hodgkin lymphoma治療的方式會依期別而有不同? 3.是否需在輔以其他檢查確認治療的方向? 非常感謝您的回覆, 謝謝病理組織學診斷: 1. Soft tissue, neck, formalin fixed, incision, chronic inflammation 2. Soft tissue, neck, normal saline, incision, atypical lymphoid infiltrates, favor Hodgkin lymphoma 檢查報告: The specimen is submitted in two separated bottles labeled as A: fixed in formalin and B: in noraml saline. The specimen labeled as A consists of onone tissue fragment measuring 1.20.40.3cm. in size. Grossly, it is yellowish white and elastic. The specimen labeled as B consists of one tissue fragment measuring 1.20.60.4cm. in size. Grossly, it is yellowish white and elastic. All for section and labeled as: Jar 0 A1:formalin A2:normal saline Microscopically, section A shows chronic inflammation with lymphoplasma cells infiltrate in the dense fibrous stroma. Section B shows fibrosis with mixed inflammation in the dense fibrous stroma. There are focal atypical lymphocytes with large R-S like cells. By IHC, most of the large cells are CD30-, CD15-, CD45 indeterminate. The small lymphocytes are mixed CD3+, and CD20+. IHC stains, for CK and CD123 are negative. The morphology is c/w malignant lymphoma, but IHC is nor diagnostic, in part because the tissue is poorly fixed. Rebiopsy is advised, if clinically indicated. The case has been presenter for discussion at the morning meeting. 補發報告:The further immunohistochemical statining of CD56, CD138, and EBER are negative to eht atypical lymphocytes and RS-like cells.

回答醫師	謝瑞坤
回答日期	2007年12月17日
回答內容	蔡小姐看了妳的病理報告實在很難回答妳的問題該報告的疑點我想妳也看過以形態而言,像是Hodgkin's disease但是卻無法使用免疫染色法來佐證由於判斷是否惡性腫瘤我們臨床醫師還是得依靠病理科醫師當病理科也有問題時我們也沒辦法,倘若妳的主治醫師有要求妳再做ㄧ次切片我會建議妳答應再做ㄧ次. 目前Hodgkin disease 的治療無論期別都是以化學治療為主視情況再加上放射治療依妳目前的狀況最好的附加檢查應該是正子掃描可以做分期,也可據此判斷是否為惡性之淋巴腫不過正子掃描須做健保審核,不ㄧ定皆可做,自費則要三萬多元,可以跟妳的主治醫師討論