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2644165 tn?1387244348

Chronic swollen lymph node... many tests with little explanation of strange symptoms

I have had some weird things happening in a year. I have seen a ton of doctors...  About a year and a half ago, I experienced something similar with a node on the right preocciptal side of neck. I began experiencing the fevers, sweats, weight loss, tinnitus, and floaters. I was in the ER three times and admitted twice with ZERO outcome of a diagnosis other than unknown. They ran a variety of various bloodwork for autoimmune and viral tests like Epstein-Barr, Julien-Barait, lupus, Lyme, Brucellosis, etc. all were negative. It was a CT of my neck that revealed the thyroid nodules. Things seemed to calm down for a slight period, but then the summer hit and a cervical lymph node on my left side has slowly become reactive. My CBC bloodwork has supposedly come back normal but my WBC counts have come back somewhat low.

The level 5 neck node (posterior triangle node) that is reactive now is painless, except I have been experiencing a feeling of dysphagia or tightness around my throat and where the lymph node is located... I haven't been losing a ton of weight this time, but I have been more tired. Further, I am concerned because I believe this chain drains my thyroid, and I have been concerned about developing thyroid cancer due to the numerous nodules I have in my thyroid. The dysphagia has been very unsettling and is a constant feeling. My doctor has told me that it is idiopathic (termed "globus") and stress related and has prescribed Xanax, but it doesn't help. The node measures 1.1x0.4x0.6 cm, and appeared to have normal flow in October when it was ultrasounded. Since then, the node feel that it has gotten larger and my doctor feels that it is still no concern and scheduled another ultrasound to look tomorrow. He did offer to excise the node with full anesthesia, but refuses FNA despite it being just under the skin surface.

Should I be concerned for lymphoma? Can the cervical lymph nodes be that large and normal in the neck despite the cutoff size of 0.7cm^3? I am really concerned because this thing has been swollen for a long time, and my doctors have been pretty condescending.
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1081992 tn?1389903637
COMMUNITY LEADER
Hi, Mike. Is it possible that the life jacket rubbed the node and inflamed it?

Also, here is your report with calcification: "the solid hypoechoic 1.2 x 1 x 0.9 cm nodule in the left inferior thyroid with peripheral linear discontinuous calcification". But that's the thyroid nodule, not a lymph node - so I suppose that does not apply to what I was thinking about blastomycosis.
http://www.medhelp.org/posts/Leukemia--Lymphoma-/Left-lymphnode-big-for-2-3-years/show/2059743#post_9764297

Then your followup biopsy was conducted, as per this study's suggestion: http://www.ncbi.nlm.nih.gov/pubmed/17901138

But there was good news for you: "This nodule was biopsied at outside on 08/31/2011 and suggestive of indeterminate follicular lesion favored benign", So I'd guess, as usual, that the same mystery immune condition is causing both the nodule and the node.
Helpful - 0
2644165 tn?1387244348
I am so sorry for the delayed response... I have recently been experiencing some new symptoms. The node in my neck feels slightly larger, and I can feel it when i turn my head or have my life jacket on for work. The pressure on the node often gives me a headache. I have also been more fatigued lately and less hungry. I have not lost weight though... I am considering calling the doc tomorrow to let him know about this, and I am not trying to get too worked up and think the worst like before.

To answer your question, I do not believe I have had a calcified node, but the ultrasound did mention hyperechoicity. The node still feels pretty rubbery and mobile and about the size of my index finger pad.

I appreciate your input Ken, and thanks for the previous resources. I will continue to keep you posted.
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1081992 tn?1389903637
COMMUNITY LEADER
Yes, Mike, that's correct.

So that mostly puts you in the position of just doing watch-and-wait, and in your case that will most likely never result in the node getting cancer-large (though a bout of inflammation might result in it getting just a little bigger).

But if your overall symptoms flare up, then that puts you in the position of trying to find out the underlying inflammatory (non-cancer) cause.

It's even possible that your change of locale might result in your never having another flareup - if there is some environmental trigger involved.


Say, did you post at one time that you had a node with calcification (or hyperechoicity that suggest calcification) around the periphery?

In case that was you, I'm going to post 2 links here so I don't lose them.

DDx of eggshell calcification, Q7: http://www.meddean.luc.edu/lumen/MedEd/medicine/PULMONAR/ct/nodes.htm

candidate:https://en.wikipedia.org/wiki/Blastomycosis
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2644165 tn?1387244348
Ken,

I am not understanding your last statement. So, a node would continue to grow with a lymphoma, but plateauing usually means benign and just reactive? Am I understanding you correctly?

Thanks,

Mike
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1081992 tn?1389903637
COMMUNITY LEADER
If any cancer was aggressive enough to grow that quickly, it'd be very highly improbable that it would suddenly stop growing further on its own.

However, that plateauing in size is exactly how a reactive node would behave.



Helpful - 0
2644165 tn?1387244348
Hey Ken,

I totally agree that there may be an autoimmune thing happening, but lately I have felt ok. The node is still pretty enlarged, but doesn't feel that it has changed much since before Christmas. Would lymphoma cause the node to get really large pretty quickly, or could it just stay at just over 1 cm^3 for 8 months? I am not trying to disagree with the onc's final opinion, but I am still concerned that this node has not shrunken, and there isn't one of equal size on my right size... Again, I am trying to make peace with my doctor's decision... The node, however, is painless and mobile and does not appear to be fixed to any other tissues...

Thanks again!
Helpful - 0
1081992 tn?1389903637
COMMUNITY LEADER
Well, Mike, the opinion from the onc is no surprise. But that doesn't address what the real cause of all your symptoms is - which I think is some non-malignant immune thing.

I'd suggest that if/when symptoms flare up, you should immediately assess and record what had been different in the preceding period. That might be exposure to foods or chemicals or heat/cold, etc.

But with luck, you won't have any flareups and can take a break. Good luck, my friend.

(A permanently enlarged node can be from fibrosis which occurred during some previous immune battle within the node.)

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2644165 tn?1387244348
Ken,

Sorry it has taken such a long time to reply. My ENT felt I should see an oncologist, so instead of any biopsies, the doctor just referred me to the cancer center in town. When I went to my appointment, the doctor looked at my records, felt the lymph node and said that my nodes aren't cancerous. He was a bit flippant, but told me that the reason I was referred was to reassure me that nothing was wrong with me. He said the nodes are just big, and that having a permanently larger node is normal. Since then, I have tried to block it out of my mind, and i am trying to take the doctor's word.

I have also since relocated to a new city for work, and my wife and daughter are stuck behind until her teaching contract is done. I am going to keep an eye on the nodes, but for now I am going to try my best to block it out of my mind. I hope all is well, and I again appreciate your insight.
Helpful - 0
2644165 tn?1387244348
Merry Christmas, Ken!

You are right about having the option of the 1st ENT. I am trying to keep my mind out of the worrying state, and I have been just trying to keep busy with family. I went for a long run , and it felt great... it was the longest I have run in months! I am certainly considering the immunologist. I was told by my doctors office that I may hear from him by Friday or the beginning of next week. I will certainly keep you posted.

As far as the Armour Thyroid, I have been on it for two days now, and so far so good!

I hope you had a wonderful holiday! I will be in touch once I hear from my doc.
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2644165 tn?1387244348
I am sorry to hear that you are in similar shoes at the moment. Also, great job on kicking cancer's a**.  To answer your question about imaging, I had a Neck CT in May 2012 when the first preocciptal node went haywire. During that CT, they found the thyroid "hypodensities." I was still experiencing neck pain, headaches, fever, and floaters, so the hospital admitted me twice and they performed a spinal tap to check for meningitis, and they ran a neck MRI with contrast that did not show any abnormalities. Last January (2013), I had another followup MRI of my neck which was also normal. In May 2013, my left cervical node became inflammed and has been that way since. Since then, the only imaging I have had completed has been ultrasounds.

I am hoping to here from my doctor in the next couple of days to see what the oncologist has told him. I appreciate your input, and I hope everything yields a good result with you as well. The uncertainty is scary, but this forum has been an excellent resource for me and been very informative.
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Avatar universal
I have some swollen nodes in my left side neck, and was diagnosed with a thyroid condition as a result of the ultrasound to look at those (it found my thyroid enlarged and scared, and blood tests confirmed high  antiboides from Hashimoto thryoiditis)

I just had a 6 month follow up ultrasound (lymphnode is still there) mine is stone hard and fixed.  They feel the size is borderline (1.5 cm) as it is a jugulodiagastric (sp?) node.  Since I am a cancer survivor with a history of severe infectiosn (sinue, ear etc) as a result of my immune dysfuntion from treatment and my cancer they are not that worried and fell it is likely just a a scared node.  But, my hematologists has asked for copies of the ultrasound results and will consult with a head and neck oncologist.  They might do a ct scan with contrast or a FNA in january. Right now they are not that worried about it, but I probably worry more!

If I was in your shoes (i kind of am?) I would not want to jump into a major neck disection surgery just yet. Have you had a CT scan or MRI with contrast? If you are going to have the node removed and there is a chance it is cancer, I think having the oncologist involved is definately the way to go.
Helpful - 0
1081992 tn?1389903637
COMMUNITY LEADER
As you probably know, lots of people who are hyopT love Armour. Just be aware of any possible allergic reactions, like hives.
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1081992 tn?1389903637
COMMUNITY LEADER
Well, having to wait for the onc's opinion conveniently provides for a mandatory time out where you don't have to be thinking about this for the next days. When the onc (probably) says that there is not justification for a biopsy, you still have the option with the 1st ENT - for a while anyway.

You might also try to see an immunologist when you get back. I think the positive antibody test is important since once a person has autoimmunity, the odds are higher that they have some other autoimmunity. I'm still guessing that you have some immune condition that's causing the swollen nodes, and the thyroid is a participant in that chain of causation. Biopsies and whatnot are means just to rule out cancer and infection.

Yep, there are too many options and not enough definitive facts to make a decision on. One strategy is just to go with whatever the top expert says, that'd be the onc at this point. The other strategy is to Sherlock the problem yourself, which of course is what tend toward :)  That can wait for a bit. Doing 20 rep breathing squats seems like a good idea for stress relief.

Merry Christmas to you and your family, Mike, as we celebrate the birth of our Lord.
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2644165 tn?1387244348
Ken,

I spoke with the assistant to the ENT I saw today regarding the TSI test, and apparently he was not concerned about Graves because the ANA and other antibody tests came back negative... I was unaware that TSI is an antibody... I feel that I am kinda stuck in between a rock-and-a-hard-place: the first ENT I saw appears to not be concerned and has the mentality, "I will take the thing out if it will make you feel better." To be frank, he has seemed short with me. The endocrinologist/ENT I saw today is consulting an oncologist to find the best plan of action to even determine if an FNA is warranted. He plans to fax all my records including those I posted to the oncologist. Further, he is supposed to get back to me sometime next week about the outcome of his consult and a possible plan of action.

Given the research as well as our discussion, FNA has its risks of being inconclusive if there really is a problem. The surgery, while more invasive, is more definitive - and I am still leaning on that as being a viable option.

As far as the Synthroid, my new doc is putting me on Armour Thyroid (30 units) effective tomorrow, and it will be the only medication for my thyroid that I will be taking. with regard to blood pressure, I have been having it checked and I am around 120/70 and 57BPM. I am a avid gym rat, and I do like squats. I have had some moments of shortbreath, but I will be sure to keep an eye out now.
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1081992 tn?1389903637
COMMUNITY LEADER
Speaking of squatting, don't do anything like barbell squats or deads if your BP is high.

The reason that high BP affects vision is that the tiny blood vessels in the retina get affected. Similarly, tiny vessels in the kidneys get affected, the heart gets worn out, the eyes even bulge out in Graves... but those are all longer term effects while a burst blood vessel is immediate.
Helpful - 0
1081992 tn?1389903637
COMMUNITY LEADER
Not crazy at all, Mike. These mystery conditions do tend to make a person feel that way. The thing to keep in mind is that you're not getting worse. In fact, you're better now than previously and mostly staying even  (with the slight exception of that one node getting larger, but still not cancer-large).

In a fit of hubris, I'll say that I'd disregard this new ENT about the excision. It's true that doing surgery on a cancerous tumor always risks setting some cancer cells free to metastasize elsewhere. But I've seen no reason on scans to think that the node's capsule isn't intact (and therefore containing all cells inside). So the risk of spreading seems small.

I also don't see any reason for a *guided* FNA. There is no focal mass inside the node that needs guiding to. However, from the start I believe I'd mentioned that a regular, unguided FNA might just find some diffuse pathogen or identify which inflammatory cells are most prevalent, and that gives a clue. (E.g., eosinophils might point to a parasite, rather than a virus or bacteria.) I urge you to try and pressure all docs to make sure that your pathology investigation looks for pathogens, not just for cancer.

Anyway, you've seen two ENTs differ. Two oncs might also differ just the same. And...

Oh, hey wait a minute! I'm going to post this fast (and finish later) so that you might read it in time to get in touch with the ENT about the thyroid result. Thyroid Stimulating Immunoglobin *is* an antibody (immunoglobulin is a synonym for antibody). It stimulates production of thyroid hormone. You are also taking synthetic T4 thyroid hormone. You should call the ENT before you leave and ask if you need to reduce your T4 (Synthroid). Check your pulse to see if it's fast - and your BP to see if it's high. Too much T4 will do that, and is a symptom of Graves Disease. Also, Hashimoto's Disease (which usually makes for low thyroid hormone) sometimes has periods when thyroid hormone goes too high.

You should probably be taking less or zero of the T4. If you don't have a BP cuff, you should get one. You don't want hypertensive episodes.

You did say that you had vision distortions at one time. Did you check your BP then? Vision distortions (like waviness)  from hypertension are a sign of a medical emergency. I don't want to be overly alarming, but once my father had BP of 200/120 and I did rightly take him to the ER. You need a cuff, and you probably don't have time to learn to use a manual one so get an automatic.

I'm talking about waviness and blurriness, not floaters.

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2644165 tn?1387244348
Ken,
I hope you are having a decent start to your Christmas holiday. We are headed to my brother's tomorrow until Friday, then we are flying out to Atlanta to my inlaws. So, far a great start to the holiday.

Today, I had my  ENT evaluation of the ultrasound. He is a new doctor I am seeing for thyroid issues because my endocrinologist is dropping my insurance from his practice... and this doctor definitely feels something is strange, and is somewhat concerned. I asked him about performing an excisional biospy and mentioned the other ENTs recommendation, and he felt the excisional biospy may not be the way to start because of concerns that if a malignant process were occurring, he fears risks of spreading disease without a more controlled process to a diagnosis... I am not really understanding this logic... However, he wants to be more conservative with the approach to determining a diagnosis. He wanted to consult the advice of an oncologist, and he mentioned starting off with an ultasound guided FNA if the oncologist deemed it necessary. I did ask him the reliability of an FNA, but he seemed quite confident in that test... However, I know that the biospy may be better as we discussed.  He was originally going to send me in for an MRI, but saw that one had already been done in the summer and the imagery was clear.

At this point, I am really unsure as to what to do, and I know I will have to make a choice to go to the other ENT and have the nodes excised and biopsied or not. The previous ENT did not order the most recent ultrasound, and is unaware of the additional, larger node on the right side, and was only aware of the one on the left. The ultrasound tech did not specify where the right node is located, and i am not sure if it is the preocciptal node that has been enlarged since last year.

My thyroid bloodwork was all within the normal range except for my Thyroid Stimulating Immunoglobin test which came back as abnormally high. No thyroid antibodies came back as out of range and my hormone levels and Vitamin D and B12 were normal, but on the lower end.

The doctor switched me to a new thyroid medicine and has me taking 10000 ntus of Vit D daily. For now, I am going to squat on scheduling any procedure until I hear what the new doctor's consult with the oncologist yields. I still may go with the excisional biopsy.

I hope you have a safe holiday, and I am sorry if I am coming off crazy.


- Mike



Helpful - 0
1081992 tn?1389903637
COMMUNITY LEADER
Thanks for saying that, Mike.  You're a class act.

I suppose I should mention something that might set your mind a little more at ease. The most likely type of lymphoma in someone who is 30 is Hodgkin's Disease. That is very treatable and has a high cure rate.  I don't think that you have Hodgkin's Disease, but that should be good to know anyway.

Yes, by Fx I'd meant family history.  Yours doesn't seem troubling.  

One thing in favor of having the excisional biopsy is that if/when they find no cancer, then there is the further opportunity to identify whatever cells (or pathogens or granulomas) are in the node as a clue to what's going on. So you're lucky that the ENT is willing to go along with the biopsy - that's your best chance of getting clues.

The risks of surgery are there but the probability is small. From what you've said about the waiting being almost unbearable, I'd recommend that you go ahead and have the biopsy - after you've asked about whether there is any special risk due to the node's location. You should be fine and be on your way home in 3 or 4 hours. Make sure to ask the surgeon how the node had looked when it was taken out. Non-Hodgkin's nodes can have an easily observable ugly appearance - I don't know if the same holds true for Hodgkin's Disease because HD doesn't grow through the enclosing capsule as non-Hodgkin's does. Then next a pathologist looks at slides, like so: https://www.youtube.com/watch?v=it0lwR3Fls0

When the pathology report comes back as "no cancer", then have a beer or two and take a few days off from thinking about this :)  

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2644165 tn?1387244348
Ken,

Thank you very much for your answers. With regard to Fx history, are you referring to family history? For family history, my mother's side - my great grandfather died of lung and bone cancer. He smoked for years, and the cancer metastasized to his bones. My dad's side - my dad's sister had breast cancer, and thank God, she has been clear for 10 years this past October. As far as other history, my family's health risks are high blood pressure, diabetes, and heart problems. My mom's dad died of a heart defect at 36 years old.

I am strongly considering scheduling the biospy, but like you said it will only rule out lymphoma, but the other question is "what the hell is going on?" I have a friend from church who is a radiologist at the facility and he looked at the images and he doesn't seem too concerned, but recommended reimaging after 6 months. He felt the CT may be overkill.

My fears are waiting too long and the uncertainty of the underlying issue if there truly is a disease lingering in my body. My wife sees me going down this spiral mentally and how scared I am, and it is horrible to live life like this. I am only 30, and I have a 3 year old girl and her to take care of. I guess my rambling is to vent, but I really appreciate your ear. I wish I could meet you in person to thank you for how receptive you have been.

I have an appointment for a 2nd opinion on Monday. The doctor is another ENT that also specializes in thyroid issues. My previous endocrinologist dropped all insurances from his practice, and I would have to self file as an out-of-network to see him... I will post what he has recommended for further treatment. I am anticipating that he would rather wait for an invasive procedure.

Thanks, Ken.

-Mike
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1081992 tn?1389903637
COMMUNITY LEADER
As a shot in the dark, I'd try ordinary Benadryl and see if anything changes. Not on workdays, though. Mark the node with ink and see if it gets smaller over two days. Just a shot in the dark.

(Btw many people with CFS decided to tough their way through it with exercise etc at first and only dug a deeper hole.)
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1081992 tn?1389903637
COMMUNITY LEADER
"With regard to the lymphopenia, do the low lymphocytes and RBC suggest something bad? "

The worst case is when a blood cancer infiltrates the marrow and crowds out normal production of blood cells (though usually it's pancytopenia). But there are other causes that produce the same result, even having a virus. There is also aplastic anemia.  Autoimmunity can destroy cells in circulation or attack the hematopoietic stem cells in the marrow. There is such as thing as bone marrow biopsy, done with a local anesthetic bjt your counts aren't low enough to do that, I'd guess. But if cancer were found in the marrow then it would likely have originated in the neck nodes.

What you say about biopsies is entirely correct. So if your main aim is to rule out lymphoma, then you should get the excisional biopsy. (But even then the results might come back as being uncertain about what some of the suspicious cells are.)

Do you have an Fx of cancer?

"bilateral" does not imply symmetry, merely being on both sides. Cancer wouldn't typically spread cross-side like that. Cervical lymphoma is far more likely to go only the same side of neck, and/or axillary and inguinal.

Your right side node has enlarged, but still only up to theoretical maximum for only being reactive.

I'm guessing the node was too deep for the sono to get a good look. (Also being deeper makes for more danger in surgery, especially to nerve or artery.) Here is a surgery being done: https://www.youtube.com/watch?v=g9lzOYtGLic

Maybe a more skilled sono operator elsewhere could do better? (Example, when doing a CIMT sono for atherosclerosis, there is a lot of possible variability and results can vary by operator. In some clinical studies, operators receive special raining beforehand. So seeing a fatty hilum with sono would be ideal, if possibly done by someone else. Just guessing.)

A little girl was in the news last week because she died from a tonsillectomy - so all surgery has catastrophic risk - besides the anesthetic risk you've mentioned.

Reasons to wait: you have alternate causes that are more likely, hinging on an unusual immune system Hx and Fx, and exposure to unusual pathogens from work. Also, no node is super-large, The big left one seems to have plateaued. (The .1 growth cm is in margin of error, I'd think.)

Reasons not to wait: my father had a bump on the  back of his neck that all docs said "don't worry", but it was indeed lymphoma. You never know, without excision.

I'd mentioned FNA if the aim was not investigating for cancer but instead investigating immune causes. E.g. here it's used investigating diffuse inflammatory pseudotumor: http://www.ncbi.nlm.nih.gov/pubmed/2588924    

Excisional biopsy won't miss focal conditions, but FNA can miss (like poking some holes in raisin bread). but FNA won't miss looking for some diffuse condition (cinnamon bread). FNA is done with a local anesthetic.

The med world has been recognizing that they need to use less radiation, some individual docs don;t agree. It seems crazy for a dentist to take x-rays every 6 months without a profound reason. In the 1990s there were actually full-body "yuppie scans", using CT to just look around for any problems. Weird stuff.

Personally, I would and re-sono in 6 months. Scan will likely be the same then, too. But I'd be willfully telling myself that it is benign. Unless there is a strong Fx of cancers.

Glad to be of help, Merry Christmas to you.

Helpful - 0
2644165 tn?1387244348
Ken,

I received the results of the ultrasound today. Overall, things look brighter, but I am still uncertain as if to whether or not schedule a biopsy. Here are the results below:

-------------------------------------------------------------------------------------------------------------
HISTORY:Palpable foci in left and right thyroid

COMPARISON: 10/17/2013

TECHNIQUE: Target sonographic imaging of the left neck was performed in the sagittal and transverse plane.

FINDINGS: There are bilateral hypoechoic masses in the left and right neck which are well circumscribed. Largest left neck mass measures 1.2 x 0.4 x 0.6 cm. Additional smaller 0.4 x 0.2 x 0.4 cm and 0.7 x 0.2 x 0.5 cm masses are noted in the left neck. Solitary mass in the right neck measures 1.3 x 0.2x 0.9 cm. When compared to the prior exam, findings are similar. The possibility of bilateral soft tissue tissue neck lymph nodes raised. Etiology and significance is uncertain. Consider CT.

IMPRESSION:

Bilateral soft tissue neck solid masses, possibly representing lymph nodes. Further evaluation with post-contrast sock tissue neck CT is recommended.

--------------------------------------------------------------------------------------------------------

Good news is that my thyroid meds have been working in shrinking the nodules. The dimensions of my thyroid lobes have gone down as well as the sizes of the larger nodules that existed in the prior ultrasound. The final impression was STABLE CYSTIC LESIONS THROUGHOUT THE LEFT AND RIGHT THYROID LOBES. NO DOMINANT SOLID MASS. NO SIGNIFICANT CHANGE.

If I am understanding the neck ultrasound correctly, when they state "bilateral" I assume that they are referring to the masses as being bilaterally symmetrical, correct? Further, I had a neck CT done almost two years ago for these issues, and I would really prefer to not undergo such radiation. I have had to have two CTs and a number of xrays in my life for broken bones and sprains (I played hockey, lacrosse, and soccer), and I am worried about all the exposure to radiation. I have even been a bit skeptical on bitewings in my dentist's office because she does them every six months...

All and all, I have had numerous images done of my neck. Last spring the MRI revealed nothing, even in my thyroid. Should I be concerned about these findings? Should I do the biopsy procedure? I am having a difficult time finding peace... I hope I am not coming off as a hypochondriac.
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2644165 tn?1387244348
I appreciate you staying in touch with me through this. Unfortunately, the technicians at the radiology office are not allowed to share any information while completing the scan. I did request a doctor that I know read's more thoroughly, personally review my ultrasound scans.

With regard to the lymphopenia, do the low lymphocytes and RBC suggest something bad?

FNA biopsy was a technique that I saw was used for determining if abnormal cells in lymph nodes, but much of the literature and forums I have read is that the technique often results in false-negatives. Further, many of these sites also suggest that excisional biopsy after removing the entire node is more accurate in determining cancers in nodes. Am I correct?

My ENT has offered this service, but because he is calling it a deep cervical node, he wants it to be a full anesthetic surgery where I will be put under. I am trying not to worry about this, but I am also about to relocate to another city for my job, and I will have to find a new treating doctor if I don't deal with this soon.

I should have the report arrive by mail either today or tomorrow, and I will post the results. Thanks, Ken.

- Mike
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1081992 tn?1389903637
COMMUNITY LEADER
Rushed typing, might sound disjointed - sorry.
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