importance of second opinion in surgical pathology referral material of lymphoma

To evaluate the importance of inter-institutional second opinion surgical pathology review of lymphoma, and identify the lymphoma pathologic mimics. The surgical pathology material of patients referred to 2 tertiary care hospitals in the western region of Saudi Arabia [King Faisal Specialist Hospital and Research Centre and King Abdulaziz University Hospital, Jeddah, Saudi Arabia], for evaluation or therapy for lymphoma over a 10-year period [August 2001 to August 2011], were reviewed. This study included only cases in which the patient referred with a diagnosis previously made at the primary institution. Of 560 cases, the second opinion diagnosis differed significantly from the initial diagnosis in 39 cases [7%]. These include changing the diagnoses from lymphoma to non-lymphoma lesions, change the type of lymphoma with major clinical impact, and change from reactive/non-diagnostic to lymphoma. Second opinion surgical pathology for lymphomas can result in major therapeutic and prognostic modifications. Thus, review of the original histologic material is recommended prior to a major therapeutic decision, and to maximize the discovery of clinically relevant major disagreements. Stringent adherence to institution's second opinion policy is an important quality assurance measure in surgical pathology

Post transplant lymphoproliferative disorder after autologous hematopoietic cell transplantation for hodgkin's lymphoma

Post-transplant lymphoproliferative disorder [PTLD] is a very rare complication post autologous bone marrow transplant with few cases reported so far. We report a case of a child with history of classic Hodgkin's lymphoma, nodular sclerosis type, who was treated with autologous stem cell transplantation Three mounths after the transplant, he developed bilateral cervical lymphadenopathy splenomegaly, neutropenia and thrombocytopenia Excisional biopsy of a left cervical lymph node revealed PTLD. The morphological pattern of the PTLD was combined monomorphic and polymorphic with plasmacytoid/plasmablastic differentiation expressing CD20 and CD79a. Kappa and lambda light chain stains show clear evidence of lambda light chain restriction. Immunohistochemistry stain and in situ hybridization for EBV [LMP-1] were positive for EBV. PCR study reveals a monoclonal B-cell proliferation with immunoglobulin heavy chain gene rearrangement. The patient was treated with predinsolone as 2 mg/kg/day over 2 weeks with tapering over the following 3 months. The white cell count recovered with regression of splenomegaly and cervical lymphadenopathy on his last visit to outpatient clinic he was in good health with normal laboratory parameters 2 years after the diagnosis of PTLD

Primary pancreatic tuberculosis mimicking neoplasm

Tuberculosis of the pancreas is extremely rare. Diagnosis of primary tuberculosis of the pancreas is often missed, because of very low prevalence and as most of the time it mimics pancreatic tumors. We searched for the cases of tuberculous pancreatitis [TP] among all the patients who underwent exploratory laparotomy or Whipple procedure for a pancreatic mass at King Faisal Specialist Hospital, Jeddah. We review the clinical, radiological and pathological findings of those cases together with a literature review. Three cases of TP were identified; two males and one female. The age of the patients is 56, 63 and 69 years. All the patients presented with obstructive jaundice and had laparotomy for pancreatic mass. Frozen and permanent sections evaluation revealed necrotizing granulomatous inflammation that is consistent with TB that was confirmed by microbiology culture. All the patients received post operative antituberculous treatment and all are in a good condition after 1-2 years of follow-up. We conclude that although TP is very rare entity. it should be considered in the differential diagnosis in patients who present with a pancreatic mass. Frozen sections evaluation at laparotomy is usually helpful for confirmation of the diagnosis and providing material for mycobacterial culture