Conflicting Ultrasound - Help Needed

[DanteTila]

Hi,

I had an ultrasound done on Aug 1st with the following description of the lymph nodes in my right armpit:

[COLOR="Red"]Aug 1st
------------
Scans through the right and left axillae show multiple lymph nodes, five on the right side and six on the left side. These lymph nodes show fatty hilum. The largest lymph node in the right axilla is 2.4 x 0.6cm and in the left axilla 2.4 x 0.8cm.[/COLOR]

Yesterday I had an ultrasound done that came back with the following report:

[COLOR="Red"]Sept 28
------------
The ultrasound shows clearly benign lymph nodes in the right axilla. The largest of these measures 2.8cm x 1.5cm x 0.9cm. It has a large fatty hilum. The lymph nodes appear to have a benign appearance. However, there cortical mantle is slightly thickened. The lymph nodes can be followed or biopsied if perferred, but a biopsy is not likely necessary based on the presence of fatty hilum.
[/COLOR]
Over the course of 2 months, the lymph node grew 3 times as wide and a 1/2 cm longer. I know the fatty hilum is still there, but can't an enlarged cortical mantle also be the start of mantle lymphoma? I'm not saying I have it, as I know the odds are slim, but I hate the wait and see approach since I did that and it has grown. Now the second ultrasound was done by a different lab, so they didn't know it grew 3 times as wide, so maybe if they did it would have changed his opinion on the biopsy.

Do you guys/gals think I am overreacting to ask for a biopsy as I am quite worried. I originally went for the ultrasound because I felt a painless/movable lump getting bigger in my armpit and neck. I also have Celiac's Disease which can increase some lymphoma's and I'm fatigued a lot. Anyways, any help is appreciated.

Thanks!

[Ken_PA]

Well, Dante, your age tends against MCL. At younger age, there is more HD than NHL.

Have you got your pathology report yet? If your FNA was guided by US or MRI, I'd guess your results might be more accurate since they could possibly zero in on the mantle.

[DanteTila]

Hi Ken,

Thanks for the response, I appreciate it.

I just had the biopsy done now. Unfortunately an FNA had to be done instead of a core needle since the location was too risky (deep node).

The radiologist and my surgeon both have conflicting opinions. The radiologist told me today she is not overly concerned since the fatty hilum looks normal. My surgeon wanted to be safe since it had grown 3 times as wide in 2 months and the cortical mantle is not thicker. I see both sides of the story. I'm just upset it had to be an FNA since this is very inaccurate.

I agree Celiac may have caused the lymph node swelling, but I just want to be sure.

By the way I am 24/male.

Thanks again!

[Ken_PA]

Hi, just some guesses: as you know a biopsy is the only way to try to find some surety while scans and other tests are only suggestive. So you have the fatty hilum which suggests not-lymphoma, while the rapid growth plus the change from oval to more rounded tends a bit to suggest lymphoma. Have you located any study which gives the percentage of people who have the fatty hilum yet the gland is still cancerous? I think that most of the research on that has to do with metastatic breast cancer, and the figure is maybe around 10% or less. With lymphoma, I don't know the figure.

(Another possible cause of mantle growth can be in the even more rare Castleman's.)

If your doc and insurance will go for a biopsy, then why not? It doesn't hurt to ask and that can give you peace of mind. My father had Mantle Cell Lymphoma, and was put through 'watch and worry' for years before a biopsy was done and diagnosis was made.

Other alternatives are CT or MRI, with the latter having the difference with/without contrast giving more clues. There is also a needle rather than resectional biopsy, but that can give false negatives.

Still, FWIW I'd guess that it all might be due to the Celiac Disease or other related autoimmune reaction. If it were me, I'd eliminate all gluten plus legumes and dairy and see what happens after a few weeks.

Good luck.

P.S. In future, you can include your age as that also is a clue.