FNAB following US

After monitoring my growing lymph nodes for a year and a half, my recent US has scared my doctor into having me get a biopsy. My question is- what do "diffusely increased in size" lymph nodes with "cortical thickening" and "absence of fatty hilum" and "loss of benign architecture" indicate typically? I'm sure there are several options but after running through an insane amount of blood work and appearing to have no active infections causing reactive nodes, I'm trying to hold on hope that there are options outside of Lymphoma!

[Ken_PA]

Hi, your US results give tendencies but aren't conclusive.

E.g., the presence of a fatty hilum almost always indicates a benign node, but the absence of a fatty hilum doesn't necessarily mean a malignancy. (The hilum is the portion of the node where the lymph vessel exits. In a bean shaped node, the hilum is at the center of the inside curved area.)

"diffusely increased in size" would mean uniformly or homogenously increased, IOW not with discreet nodules (lumps) inside.

"cortical thickening" refers to the cortex, which is the main mass of a node, being mainly the outer and middle area (the medulla is moreso at the core near the exit by the hilum)

"loss of benign architecture" well, that's maybe the most concerning. Think of slicing a tomato and seeing it's structure: it has pulpy ribs and seeds and chambers, etc. Now think of a slice of a potato, its all the same. If a tomato turned into a potato, that'd be loss (effacement) of its architecture.

Altogether, that warrants a biopsy for sure - but on the other hand... what you'd want to hope for is that prolonged and unusual inflammation could also create all of the changes seen on your sono. In fact, there is such a condition as "inflammatory pseudotumor" in which your immune system pretty much destroyed the inside of those nodes over time and replaced the contents with what amounts to scar tissue.

In fact, I looked at your other posts and see the nodes were growing one after another for a year and a half, yet they seem to have each stalled their growth at about 2cm. That's not typically how cancer would spread.

So my guess is that you do indeed have inflammatory pseudotumors. This should interest you:
http://www.ncbi.nlm.nih.gov/pubmed/9042798

Note the stages, which can guide you on what to expect to see in the pathology report: either stage II fibroblasts and immune cells, or else in Stage III only left behind scar tissue and the cells are mostly all gone by now.

So in a strange way, you can hope that you have a mystery immune-based condition that will be hard to pin down and maybe harder to treat - but it's not cancer.

I hope this makes you feel better. Good luck.

Also be aware that needle biopsies are prone to false-negatives, but in your case that seems less likely.

If you can post back with you biopsy path report, that would be helpful to others who come along.

(Btw, if you get back on heavy-dose pred there are ways to avoid weight gain and moon face and prediabetes, etc)

[jlswood]

I actually have never heard of that so thank you for the information! I reviewed all the imaging and yes I did have them stall slightly in increase however they have since all increased significantly. Seems very strange to have swollen lymph nodes for years at a time! I have not been on steroids since September. I am now 5 months pregnant and luckily that has kept me off the steroids. I will definitely post the results of my biopsy when they become available.

[Ken_PA]

"they have since all increased significantly"

The critical question then is: how big is the biggest one? If over a certain size, that needs addressing right away. What is the size?

[jlswood]

They are over 2 cm each but i do not know exactly. The new ENT I saw was terrible and blew me off- long story. My OB, my PCP, and two friends that are physicians all disagreed with him and told me to never trust my care in him and go back. Now I have a few biopsies scheduled at the hospital tomorrow with a radiologist and will hopefully have answers soon. Whatever it is, I'd like to find out soon because after two years of lymphadenopathy and poor health it would be nice to fix the problem instead of just treating symptoms and monitoring!

[Ken_PA]

Hi, since you mean a radiologist do you mean they did guided needle biopsies? How did that turn out? Your case is probably quite rare.

[jlswood]

They did a guided biopsy on just one node- the jugulodiagastric node. Results are inconclusive. I have no idea what the next step is.

[Ken_PA]

Thanks for posting an update. They might suggest "watch and wait" aka "watch and worry". You'd look for any change especially in size, but also shape or firmness or even tenderness. For size, you'd watch for any one getting larger than that node could get by simply being reactive.

Another option would be having another pathologist examine the same sample for a 2nd opinion, or else do some more extensive (and expensive) testing on the same sample.

"Inconclusive" would typically mean that the cells look odd, but are not definitive for cancer. Yet odd looking cells might be pre-cancerous.

You could post the text of the path report here.

You might try scouring the web to find others with inflammatory pseudotumor, to see if you are similar to them. Good luck.