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| Year : 2015 | Volume
: 58
| Issue : 2 | Page : 266 |
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| Spectrum of lymph node pathology: Authors' reply |
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Rakhee Kar, Debdatta Basu, Bhawana Ashok Badhe, Arun Roy
Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
Click here for correspondence address and email
| Date of Web Publication | 17-Apr-2015 |
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How to cite this article:
Kar R, Basu D, Badhe BA, Roy A. Spectrum of lymph node pathology: Authors' reply. Indian J Pathol Microbiol 2015;58:266 |
Editor,
We read with interest the letter by Pai and Kulkarni [1] entitled "Spectrum of lymph node (LN) pathology: Inadequate data, challenging issues" in response to our article [2] and appreciate some of the valid points raised by them. However, we wish to also clarify some of the points raised by them.
First point is regarding the information from the requisition form. Generally, we depend on the request form and we maintain departmental archives for all LN in the form of a LN register, wherein all the information is noted. In the case information is inadequate in the request form, every effort is made to collect information from the case records.
The next point regards how many of Kikuchi's disease turned out to be systemic lupus erythematosus (SLE). There was none to the best of our knowledge, and there is a prior publication from the department in which also none of the four cases reported had SLE. [3] The causes of infarcted node could not be ascertained, and we wish to point out here that follow-up is not very robust for all patients visiting the hospital.
Next issue is regarding our mentioning paucity of data similar to our study and missing to reference the two articles from Southern India, which has been brought to notice by Pai and Kulkarni [1] We regret having missed these articles in literature search and appreciate that they have been brought to notice. As mentioned by them, the greater percentage of malignancy could be a referral bias as this being a tertiary referral centre offering free treatment, we do get a lot of referred cases.
The next point regarding site of LN biopsies is valid; however since the data was missing for many forms we could not include it. Nevertheless, it is an important point for any reader wishing to undertake a similar study. The percentage of acid fast bacilli positive tuberculous lymphadenitis is also important information, which we could have included.
The query regarding the impact of fine-needle aspiration (FNA) on the practice of LN surgical biopsy was not mentioned as our study was not about the utility of FNA in LN pathology. We have undertaken a study on these lines and would be able to say something on this only after the study is complete.
The other points about how many cases needed step cuts, immunohistochemistry, etc., are extremely redundant and not in the scope of the article. Each case was diagnosed as per standard protocols of diagnosis. If step cuts or immunohistochemistry were considered necessary, they were done.
The next question raised is that of rediagnosis after WHO 2008. We have been following the WHO guidelines since 2001. [4] There has not been much alteration in the lymphoma diagnosis between 2001 and 2008. Whatever changes have been made are mainly in leukemias and myelodysplastic syndromes (MDS) and not so much in the usual lymphoma diagnosis. Our center had collaborated with Tata Memorial Hospital and switched to WHO 2001 then to WHO 2008. [5]
The last question regarding ethical issues, change of diagnosis do not come under the purview of this article; however as pointed out by authors, we came across a recent study addressing this issue from a referral centre in the west. [6]
In conclusion, what we can say is that some of the points mentioned in the letter are pertinent while some are redundant. Our article focussed on the spectrum of lymphadenopathy in our centre; including all the points that they have raised would have lengthened the article unnecessarily while including the pertinent ones would have improved the article.
 References | |  |
| 1. | Pai SA, Kulkarni JD. Spectrum of lymph node pathology: Inadequate data, challenging issues. Indian J Pathol Microbiol 2014;57:522-3.  [ PUBMED]  |
| 2. | Roy A, Kar R, Basu D, Badhe BA. Spectrum of histopathologic diagnosis of lymph node biopsies: A descriptive study from a tertiary care center in South India over 5½ years. Indian J Pathol Microbiol 2013;56:103-8. [ PUBMED] |
| 3. | Basu D, Mutha SM. Histiocytic necrotizing lymphadenitis (Kikuchi Fujimoto Disease) - a report of four cases. Indian J Pathol Microbiol 2002;45:89-91. [ PUBMED] |
| 4. | Kalyan K, Basu D, Soundararaghavan J. Immunohistochemical typing of non-Hodgkin's lymphoma-comparing working formulation and WHO classification. Indian J Pathol Microbiol 2006;49:203-7. [ PUBMED] |
| 5. | Naresh KN, Agarwal B, Sangal BC, Basu DD, Kothari AS, Soman CS. Regional variation in the distribution of subtypes of lymphoid neoplasms in India. Leuk Lymphoma 2002;43:1939-43. |
| 6. | Bowen JM, Perry AM, Laurini JA, Smith LM, Klinetobe K, Bast M, et al. Lymphoma diagnosis at an academic centre: rate of revision and impact on patient care. Br J Haematol 2014;166:202-8. |
Correspondence Address:
Dr. Debdatta Basu
Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry - 605 006
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0377-4929.155366
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