I need a pathologist with expertise in the evaluation of non-hodgkins lymphoma to evaluate a bone marrow specimen. Yes, the hospital has had their pathologist evaluate the specimen; however, the pathologist recommended a "drill down" (my words) to further determine if this was an sll/cll or mantle cell lymphoma.

The bone marrow specimen taken prior to chemo demonstrated a positive cd-20, cd-5, and bcl-2. Negative for cd-10, bcl-1 and bcl6. Cd23 stained the dendritic networks, but not the lymphocytes. Lambda and kappa did not help demonstrate monoclonality.

The pathologist's summary stated that the findings were diagnostic of bone marrow involvement by a cd-5 positive small b cell process. Mantle cell lymphoma and chronic lymphocytic leukemia/small lymphocytic lymphoma are considered. He recommended cytogenetic studies to further subclassify the lymphoma.

A chromosome test was performed to show that my husband was a normal "xy" male. (well, that's a relief!) no abnormalities were demonstrated in this test.

At this point, chemo was begun with chop rituximab. I'm unsure whether this therapy will address the cd-5. Does anyone know?

The oncologist was most irritated when I asked if the pathologist's recommendations had been followed, or if it would be done on the next aspirate (after chop rituximab). I cannot get any help from this doctor and because my husband is a veteran, I can't change doctors because he only has medical benefits through the va hospital. (no outside insurance)

my thought is, if I can demand an additional sample and request the hospital to send the additional sample to a reputable pathologist that specializes in lymphoma/leukemia; then I could get detailed diagnosis and subsequently more appropriate treatment, or is this the most appropriate treatment; frankly, at this point, i'm not convinced it is.

Suggestions? Recommendations?

Thanks ever so much for your help.