Lymphoblastic Neoplasia

Dangerous Errors in the Diagnosis and Treatment of Bony Tuberculosis by Dr. med. Alexander Herzog in volume 36/20090

In my opinion, the main error lies in the initial, inadequate diagnosis in the context of CT guided biopsy. Further information about the exact histological findings would have been desirable.

To base lymphatic leukemia (ALL) therapy merely on a diagnosis of suspected differentiated T-cell lymphoma seems questionable, to say the least. On the one hand, the term “differentiated T-cell lymphoma” is not a widely used medical term; on the other hand, ALL is an immature, lymphoblastic neoplasia that can be confirmed by markers such as terminal desoxyadenylate transferase. In view of the consequences of such a diagnosis, statements such as “consistent with ALL” should not have been used. I don’t see any scope for different interpretations on the basis of the patient’s history. In case of doubt, a fresh and bigger biopsy specimen should be taken, and if there is still doubt, molecular genetic testing should be used to confirm the clone (T-cell receptor rearrangement).
DOI: 10.3238/arztebl.2010.0148b

Dr. med. Lars Fischer
Charité Campus Benjamin Franklin
Hindenburgdamm 30
12200 Berlin, Germany
[e-mail]

References

1. Herzog A: Case report: dangerous errors in the diagnosis and treatment of bony tuberculosis [Gefährliche Fehler in Diagnostik und Therapie einer Knochentuberkulose]. Dtsch Arztebl Int 2009; 106(36): 573–7.