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FANAC, USG and CT scan of abdomen done. What does the finding says? What treatment should be done?

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dear doctor,

Please note below FNAC report of my father (63 year old) followed by USG & CT scan report. Please advise about below and what treatment he can take. This will be controllable or not ? also please advise your email details so that we can also send you report by emails.
your urgent reply would be highly appriciated

1 - FNAC – Microscopic –Findings Mostly erythrocytes seen . Rare cells consistent with large cell Non –Hodgekin Lymphoma are noted. Excluded acute leukenia on blood counts

2- USG – Findings – Few enlarged pre & paraaortic nodes are seen in the supraumblical region measuring 40 mms size with paraaotic nodes showing evidence necrosis within them . There is
Increase in adjoining soft tissue echogencity , suggesting extension of inflammation. ------ Small reducible left sided inguinal Hernia.

3- Oral & I.V. Contrast C.T. of whole abdomen .
Findings --- Multiple enlarged lymph nodes in the mesentry with streakiness in surrounding fat Planes largest extent ofconglomerate mass measures 90 x58 mm and exihibits
Homogeneous enhancement with no obvious necrosis or calcification and encasing
The mesenteric vessels finding are suspicious for Lymphoma ?
------- Small cystic area in left inguinal Region ( Reduced Hernia )

Posted Tue, 23 Oct 2012 in Cancer
Answered by Dr. Indranil Ghosh 2 hours later

I feel that your dad is having lymphoma as per the CT and FNAC report. However the FNAC report is not very clear cut. We also need a host of other tests which are not possible on FNAC. Hence he will need a CT guided biopsy from the mass.

A whole body PET-CT and bone marrow biopsy will be required to complete staging.

This disease is potentially curable by chemo and/or targeted therapy as per final biopsy report. Please consult a specialist oncology center for needful.

You may upload reports in this website.

Hope I have answered your query, I will be happy to answer follow-up queries, if any.
Above answer was peer-reviewed by
Follow-up: FANAC, USG and CT scan of abdomen done. What does the finding says? What treatment should be done? 19 hours later
Dear Doctor,
I am highly great full for your sharp reply. Kindly throw a focus flood of light upon the points below -

1. As per report USG reveals 40mm size node but C.T. report reveals its size 90x58mm, with in the gap of 21 days i.e USG on 07.09.2012 & CT on 28.09.12. The growing & development rate such as possible ? (both the report uploaded)

2. C.T. guided for FNAC not for biopsy. Whether on punching for FNAC the rate of development may increase due to irritation of the Lymphoma ? and as per your suggestion biopsy may also vary the rate of growing on irritation.

However we are going to P.G.I Chandigarh. Please advise us what effect on punching for FNAC or biopsy on growing rate ? and the facilitation about this disease in the P.G.I Chandigarh or any other institution as per our Knowledge.

My dad is feeling nothing abnormality from any kind of symptoms till today. It is detected for 1st time in USG while checking up inguinal Hernia. Morning walk may effect any adverse or not ?

Kind Regards XXXXXXX
Answered by Dr. Indranil Ghosh 5 hours later

1. CT scan is more sensitive and also USG is not very good for mesenteric nodes; hence the size on CT is likely to be more anyway. However, lymphomas can grow also in short-time (especially the high-grade ones).

2. I know that it was FNAC but he needs a biopsy for further categorization and if any targeted therapy needs to be given (like rituximab). FNAC or biopsy does not increase growing rate.

PGI Chandigarh is a good institute for lymphoma. Dr Shubhash XXXXXXX deals with these cases there. He can continue his morning walks.

Best wishes.
Above answer was peer-reviewed by
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