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Enlarged posterior cervical lymph / second opinion

Hallo,

Back in September I noticed an enlarged lymph node on the left side of my neck located a little over 3 inches down from the ear lobe and slightly behind (which most likely makes it a posterior cervical lymph I think). My guess is that it's been around 1 cm, maybe slightly bigger. Feels movable, slightly ellipsoid / elongated shape, and usually not tender. I honestly don't know if it has grown since then or not, but it's been definitely visible through the skin in certain neck positions (which of course, the OCD that I am, convinces me that it has grown). I also think it may vary slightly in size, feeling, or tenderness depending on time of the day, stress level, etc., but that's too subjective obviously.

Worried about it, I looked for a "similar" sized node on the right side to justify the existence of the one on the left side. I did find one, albeit smaller and less noticeable (<1 cm), and a little deeper into the neck, at about the same ~3 in vertical distance, but at the level of the ear lobe, not behind it. If I never got worried about the left one, I would have totally ignored the right one as it does feel normal more or less.

Since September:

- I saw a primary care doctor in December who did standard blood work (CBC, CMP, TSH), chest X-ray, and soft tissue x-ray on neck, all came back "normal." Doctor said to not worry about it, it's likely a fibriotic clogging / left over virus clogging, or cat scratch fever. I wasn't convinced, and suggested we do biopsy, but he said he was convinced this is nothing serious.

- I saw another primary care doctor this week (early February) as I am not at ease. I don't think the left one has grown in size, but it has definitely "grown" in my mind in terms of awareness and visual discomfort, which somehow makes that part of the body more sensitive (you know that OCD feeling that something is "wrong" in that part of the body). Doctor was a little concerned as the left one has been there for many months, and the second one, albeit smaller, is there too. He referred me to ENT doctor for biopsy as this is the only way to really know what's happening. He said this is an unlikely spot for left-over respiratory clogging, although he didn't rule out the cat scratch bacteria.

About me: Healthy, fit 34 year old male, no history of any serious disease, occasional chronic sinus and left ear infections, and very mild reverse psoriasis (shows up occasionally around inner thigh / groin area). Very allergic to cats, and have been exposed to cats 6-7 times over the last 6 months (as well as for 1 year continuously back in 2007/2008). No other symptoms of any kind - no fatigues, sweats, headaches, spleen pain, etc.

Questions to the community:

1) I know this is an alarming situation, so how likely is for this case to be lymphoma? It's kind of disturbing to know that absolutely no symptoms could still mean you have the disease, although it would likely mean it's in early stages I am assuming.

2) Are there other, benign reasons for this? Are there any statistics of malign vs. benign outcomes in these unusual lymph places? At this point, are the statistics in favor or one or the other?

3) During my ENT appointment, I am definitely insisting for a biopsy, and I am sure the ENT would agree. Are there any other tests that can be done before that for guidance?

Thank you for any insights. Needless to say, I am quite worried.
4 Responses
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Avatar universal
PS: My answer was a bit too long, didn't mean to overwhelm the community. Long story short, I was a little surprised by the confidence of the ENT doctor that the situation doesn't require any further steps. I guess it's always a good idea to monitor and check again with the ENT at a later point if needed.

Thanks again.
Helpful - 0
Avatar universal
Ken, thank you for your thoughtful response and insight. I did see the ENT specialist, who after an evaluation said my situation doesn't meet the minimum conservative criteria for sonogram or biopsy, and that I am totally fine. He said the lymph is smaller than my perception (definitely around 1 cm), freely moving around, no inflammations, no growth over a long period, etc.

I pushed back strongly, but he assured me there is no way this could be a lymphoma, and to trust his opinion and experience (He gave me detailed description of what a lymphoma node feels, looks, and experiences like in terms of size and growth based on numerous lymph surgeries he said he does all the time).

When I asked what specifically then has caused the enlargement, he corrected me that the enlargement in my case is within normal limits, especially given my active age, very strong immune system, and psoriasis condition. He noted there is a major nerve going through that part of the neck, and enlargements around that area are not uncommon over time.

I did push again, at which point the doctor had to reference his M.D. and Ph.D. in Medicine from a top East Coast school to calm my concerns.

I would have liked to see at least a sono, but I guess at some point I need to trust the ENT specialist. He said if I need a re-assurance to see him again in 3-4 months, but his opinion will not change.
Helpful - 0
1081992 tn?1389903637
COMMUNITY LEADER
Hi, the general stats go something like this: for every 100 patients who see a doc because of a node that hasn't gone down, 4 get a biopsy and 1 or 2 are cancer. There are no stats AFAIK according to location.

You are correct to mention your autoimmune inverse psoriasis, since that makes your having strong immune reactions more likely than average. Fibrosis in a node can be from an especially notable infection like cat scratch fever, or from an especially reactive immune system like you probably have.

I wouldn't be alarmed at this point. Have you had the sono?

Helpful - 0
Avatar universal
This community doesn't seem very active. As I am learning more and more about these cases, it seems that ultrasound / biopsy is really the only way to get a definitive clarification. All else appears to be speculation at this point.

Still would appreciate any insight, advice, or similar experiences. Regards.
Helpful - 0
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