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Family Medicine (Expert Forum)
GENERALIZED LYMPHODENOPATHY
Questions in the Family Medicine forum are answered by Dr. J.M. Keyes. Topics covered include general health issues, adolescence, babies, child health, eating disorders, fitness, immunizations and vaccines, infectious diseases, medical tests and procedures, and senior health.
GENERALIZED LYMPHODENOPATHY
by NURSEBUFFY, May 26, 2002 12:00AM
BEGINING IN jAN 02 I FOUND A 3CM LYMPH NODE IN MY GROIN AFTER CHECKING THE REST OF MY BODY OTHERS WERE FELT IN THE NECK CLAVICLE AND ARM PIT REGION. i HAVE HAD TWO BIOPSIES (NECK AND GROIN) EACH SHOWED HYSTOCYTIC PROCESS. MY LDH WAS 400, WBC 17 and platelets 140, h&H was normal, monocytes were low. I had a pet scan which only showed uptake in the right groin area where i had a biopsy done the week before. I had CT of the head, chest and abdomin and pelvis. all were normal except there was not confirmation of left ileac region lymphodenopathy vs looped bowel on the pelvic ct and the chest xray showed a possible multiple nodular goiter to the lower pole of the thyroid. All the tests began occured between Jan and March since that time I have progressively feel worse with bouts of sever fatigue and muscle and back pain with new nodules that have occured in the fascia are of my low back. I was sent to an infectious disease doctor who ran many tests which all showed negative results (cat scratch fever, lupus, lime, sarcoidosis, HIV Hep ABCD and many others I can not pronounce. I am at my wits end. I have a bad family history of leukemia, lymphoma, colon cancer. Does the pet scan being relatively normal rule out all these forms of diseases? Is it true the longer you lymphatic system is inflammed the increased risk you are for getting cancer? Also I had so much swelling in my neck a few weeks ago it caused a compression to the nerve of the jugular of carotid causing sever pain and discomfort. The doctor started my on prednisone and celebrex which has helped he swelling in the neck but the nodes are still the same. None of my nodes are tender to touch. Any suggestions would be helpful. Also my primary doctor ran tests for STD's and this was also negative. My primary doctor suggested another biopsy of the new subcutaneous nodules that have came up on my upper back fascia region. I declined at this time, should I have? I have been extremely nervous through this all with a feeling like my nerves are jumping out of my skin then other times so weak and muscle back pain I cant hardly function. The doctor is sending me to an endocrinologist since the ct scan showed the possiblitlity multinodular goiter. Also a bone scan is scheduled also. Any suggestions Do you think they should run a test for leukemia or does the Pet scan show this also.
Doctor's Answer
by Forum-M.D.-DT, May 28, 2002 12:00AM
Thank you for visiting the Family Practice Forum.
It certainly sounds like you have had extensive testing done. Your WBC count is high which makes me think there is some type of underlying inflammation or infection in your system. A biopsy of the lymph nodes in question would help rule out Leukemia or other malignancies. What you have is generalized lymphadenopathy and it doesn't sound like there has been a definitive diagnosis made as of yet.
Polymyalgia Rheumatica as well as Fibromyalgia are possibilities here. To my knowledge a PET scan would not necessarily "rule out" leukemia. Without a doubt your thyroid needs to be looked into further, however, I am unaware of any thyroid abnormality whether it be HYPO or HYPERthyroidism that is associated with generalized lymphadenopathy. Inflammation of the lymph nodes does not increase the occurrence of cancer. My concern is that you are being put through the "mill" of one test after another without getting any answers.
1. A biopsy would help rule out cancer.
2. Your generalized lymph node enlargement makes me think of the conditions I listed above.
3. A Rheumatologist may be the doctor who may best help answer your questions.
4. I am highly suspicious of Fibromyalgia based on the symptom complex you describe.
5. You need further Thyroid testing.
I hope this helps.
It certainly sounds like you have had extensive testing done. Your WBC count is high which makes me think there is some type of underlying inflammation or infection in your system. A biopsy of the lymph nodes in question would help rule out Leukemia or other malignancies. What you have is generalized lymphadenopathy and it doesn't sound like there has been a definitive diagnosis made as of yet.
Polymyalgia Rheumatica as well as Fibromyalgia are possibilities here. To my knowledge a PET scan would not necessarily "rule out" leukemia. Without a doubt your thyroid needs to be looked into further, however, I am unaware of any thyroid abnormality whether it be HYPO or HYPERthyroidism that is associated with generalized lymphadenopathy. Inflammation of the lymph nodes does not increase the occurrence of cancer. My concern is that you are being put through the "mill" of one test after another without getting any answers.
1. A biopsy would help rule out cancer.
2. Your generalized lymph node enlargement makes me think of the conditions I listed above.
3. A Rheumatologist may be the doctor who may best help answer your questions.
4. I am highly suspicious of Fibromyalgia based on the symptom complex you describe.
5. You need further Thyroid testing.
I hope this helps.
