Could it be Lymphoma

[Jose18742]

Sometime in late December I noticed a swollen lymph node on neck-jaw. I had a cold so decided to wait. January 29th I visited my doctor who prescribed antibiotics, ordered bloodwork, urine test and sonogram. February 13th went back for results: sonogram (2 large left cervical lymph nodes may require biopsy 14mm & 16mm) blood work was in normal range I will list most items below. My doctor referred me to ENT. I  visited two ENTs both surgeons, first one said he thought it was a tongue muscle which me and my wife explained to him could not be because it was spherical he disregarded it and said I was fine. The second said he "thought" it was a salivary gland but ordered a ct scan to be sure. I had no other symptoms until 3 days ago i started having mild tingling (not really itch)all over (I have been extremely anxious and stressed and not sleeping well), I had some chills last night and sweating, I have not lost any weight or had any fevers and right now my lymph nodes are barely noticeable about 30% of wast they were before(i had a little bulge on side of neck) . Can all the symptoms be a coincidence. Why would swelling go down so much and considering the swelling began little over 2 months ago does this help in treatment?? Sorry for long post I am new trying to get info. thanks!!!
wbc 4.3                    hemoglobin 14.8                 neut ab 2.0                 imm granulocytes 0                  ast 21                                                              
rbc 4.68                   baso% 2                              lympho ab 1.9             imm granul abs 0                      alt 18
mcv 92                     neut% 46                             ab mono .2                 imm cells canceled                   billirubin .6
mch 31.6                  lymph% 45                          ab eosin 0                  nrbc canceled                            ldh 151
mchc 34.3                mono% 6                             ab baso .1                 hematology comments cancel
rdw-cv 12.6              eosin% 1                             platelet cnt 212          hematocrit 43.2
URINALYSIS was completely normal                                                  
    

[Ken_PA]

Well, cancerous nodes are rarely painful (pain comes usually from pressure against the containing 'capsule').

Diabetes mellitus: the body wants to get rid of the excess blood glucose partly by excreting via the kidneys, then tries to get rid of the resulting dangerous glucose levels in the bladder via frequent urination. Is your back pain at the kidney area? (There's also Diabetes Insipidus, from hormone dysfunction, too little antidiuretic hormone.)

Benadryl didn't help the polyuria? That might eliminate histamine and/or endogenous interferon.

"and some do... go away" doesn't sound like cancer.

Since your CT did not look at any node's architecture, you might want to ask for a sono of the worst one someday. Presence of "fatty hilum" would be very good.

But it's looking like your generalized lymphadenopathy is reactive and not malignant. Yes, autoimmunity can be associated with enlarged nodes. How about trying a natural TNF blocker like turmeric?

"in my upper back/chest just to the right of the spine/heart" doesn't mean supraclavicular, right?

No new medications?

Is your heart rate up during flares?

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[leilajax]

Thank you so much for your response!  My autoimmune issue with Hashimoto's is just beginning to affect nearly every part of my body.  It most definitely could be causing the pain in my feet and my lymph nodes are painful (not painful when I touch them, but just an overall awful ache).  I have tried antihistamines in the past and they offer no relief other than a nap.  As, to the diabetes... it is very well a possibility as Hashimoto's can induce blood sugar problems.  My morning (fasting) blood sugar has been high for the past few weeks and yet drops after meals.  I am also having considerable pain in my lower left back for a week now.  It's not muscular, but an awful ache inside there towards the back.  All of these pains worsen when these lymphnodes get bigger.  Some never reduce in size, some become cystic, and some do reduce or go away.

CT neck/chest w/contrast results:
At the clinical region in the right posterior neck, as indicated by a cutaneous marker, there is shotty adenopathy within the posterior paraspinous space.  The head and neck review is otherwise normal.  The airway as well as the pharyngeal spaces, the hypopharynx and the glottic/supraglottic spaces are morphologically intact.  Salivary gland morphology is normal as is the vascular display.  The base of skull review is likely unremarkable.  At the thoracic inlet the angiographic review remains normal.  There is no indication of adenopathy.  The chest is clear.  Hilar and mediastinal reviews are unremarkable.  There is no indication of consolidation or effusion in the chest.  There is shotty adenopathy in the axillae.

I have a general aching pain (not when touched) in the areas of "shotty adenopathy".

[Ken_PA]

Hi, the only way to rule out cancer for sure would be via a resectional biopsy. Or, if a 'fatty hilum' was found on a scan, that's also a very good sign. Can you post the text of your scan results? Other features might be relevant.

Also, I'll suggest this: immune system signalling chemicals can cause some of your symptoms. E.g., histamine might make for tender (and swollen) feet, even though the swelling might be slight.

Polyuria and polydispia is common in Chronic fatigue Syndrome - not AFAIK from any blood cancer. The mechanism in CFS in unclear, but is immune related.

I'd try an antihistamine (e.g. Benadryl) and see if any symptoms get better.

Any reason for you or Riley to suspect diabetes?

[leilajax]

I feel so dehydrated.  I feel as soon as I drink a glass of water I pee it right back out.  My skin (pliable doesn't bounce back when pinched) and my eyes are so dry.  I also have severe constipation and lower back pain and I''m so tired.  Having hashi masks so many other health issues.  My WBC is opposite of yours I'm always in between 3.2 and 5.0.  I also have high blood calcium which I read is a marker for lymphoma, leukemia.  I don't want to be paranoid though if it's just my thyroid messing with my body, I just would like this cancer scare ruled out!

[IndigoRiley]

^ leilajax, My dr was SURE i had lukemia and sent me to the oncologist about 3yrs ago. My cbc came back with my WBC 16,000(when i wasnt even sick) and he finally realized that the lymph nodes i was concerned about werent getting smaller. Well i went to the oncologist and she said i was fine but that was the most stressful month of my life. & i STIILL believe that i have lymphonma or leukemia bc my lymph nodes are always ssoo swollen and my white count still gets up to 16,000 for god only knows what reason.         & on average i get up to urinate roughly 13 times through the night. THAT in and of itself is a HUGE reason i am unable to fall asleep until 430am most nights. It blows. I cant fall asleep when it feels like i have the urgency to urinate every 10mins, or sometimes every 5mins. I dont ever wet the bed or anything like that. But that feeling of having to GO is HORRIBLE.

[leilajax]

I just popped on here to ask about my own concern for lymphoma symptoms that have been progressing, but your posts help me realize that my enlarged lymph nodes are probably due to advanced Hashimoto's thyroiditis.  I have lymph nodes and clusters popping up left and right.  The most concerning one is that one that I feel in my upper back/chest just to the right of the spine/heart.  It feels like an inflated balloon in there, vibrates when I speak, causes pain from the pressure, and my heart to skip a beat when I bend over.  However, it comes and goes (more coming than going, I must admit though) in severity.  Noticeably  though, I have "shotty adenopathy" in my neck and axillary and most recently noticed a node the size of a marble poking out of my upper side.  Also, pain in the bottom of my feet (even in the morning before I get out of bed), infrequent night sweats, frequent urination, severe weight loss for no reason (currently 93 lbs., about 20 lbs. underweight).  Low/low normal WBC, high RDW, and CT scan 3 months ago only detected the "shotty adenopathy".  Sorry to kind of butt in on this post, but I just thought that the thyroid thing was related as Hashimoto's is an autoimmune disorder that attacks the thyroid.  What do you think?

[Ken_PA]

Hi again, Jose.

Yep, your history with the thyroid does explain the aggressiveness in diagnosis now. Still, the two enlarged nodes don't seem large enough at this point to necessarily assume a cancer.

Be aware that "head and neck cancer" is not the same as a lymphoma. That's outside my area of familiarity.

On the scan they are apparently looking for any nodules of head and neck cancer that might be inside the nodes. The nodules, if present, would be enlarging the nodes overall. But nodes can also be enlarged because of an active immune system.

Think of doing a CT scan of a tomato: if the structure is seen to be normal, then cancer is not likely, even though enlarged. The nodes would be "reactive" and not malignant. They're looking for odd bumps inside, or even looking for the lack of normally expected structure.

If the structure looks normal then that should be a very good sign and they likely won't see any need to do a biopsy.

You can take the mental approach that tomorrow's scan is being done to rule out cancer. I'd ask the tech doing the scan to tell you what they had seen, sometimes they will give info even though technically they're not supposed to. You do have reason to be optimistic at this point. Good wishes to you.

[Jose18742]

I have a ct of neck with contrast tomorrow 25th and appointment on 26th with ENT for results...keeping my fingers crossed.

[Jose18742]

Thanks ken I appreciate your insight more than you can imagine!!! Maybe I can clarify...My doc sent the sonogram because I have an enlarged thyroid and wanted to make sure the lymph nodes were not something bad with thyroid. The sono reads "In the left cervical region there are two large lymph nodes lateral to the thyroid gland measuring 16 and 14 mm. Large cervical lymph nodes should be further characterized generally by biopsy if they are persistent for they frequently harbor head and neck neoplasm. Recommendation:correlate with nuclear medicine if appropiate. Further characterization of the cervical lymph nodes required. Biopsy may be appropiate. Regarding the excisional biopsy is there any other way to fully rule out anything bad??? I believe the shape of the submandibular lymph nodes are like a lima bean spherical/oval. And the tongue muscle was "ridiculous" by a dr. who is chief of staff at a major hospital. The ldh range was 0-225.
Again thanks Ken and anything you could add would be very welcome.

[Ken_PA]

Hi, if the nodes went down to only 1/3 of what they were, that pretty much rules out cancer. The nodes were most likely "reactive" and not "malignant". Reactive = swelling up when the immune cells inside multiply to do their job.

The general symptoms could have been from anxiety. Also, stress can weaken the immune system.

As far as the behavior of the nodes? For every 100 people who have enlarged nodes that last long enough so they go to a doc: 4 get a biopsy and only 2 are malignant. So 98% are not malignant.

From what you've written:
- I don't see why the 1st doc ordered a sono, unless you insisted
- what was in the sono report that made the radiologist think of having a biopsy? the size doesn't seem to be above what can be normal for reactive nodes so what else was mentioned to justify a biopsy?
- it's good you didn't have an excisional biopsy, since nodes have a useful job to do
- are you discussing a "submandibular" node as being spherical?
- the "tongue muscle" thing sounds odd

I haven't memorized many of the test ranges, but assume you would have mentioned if any were flagged. But is the LDH flagged as a little high on your report? Ranges can vary by the lab doing the test.

If you've were highly stressed before this all began, that could have let a virus take hold (which antibiotics don't touch) and weakened immunity let it run on for a while. Sometimes an infection can exist right inside a node.

A salivary gland can be infected or have a stone, but a stone would probably have felt harder than a swollen gland. Pressing on a problem gland might make it temporarily worse.

Lymphocytes seem high normal, they are the cells that generally fight viruses.

Hope that helps.