Inguinal lymph node inflamed.

[Mincumihai]

Greetings,
I was diagnosed with a herpes about 1 month ago, it healed quite slow, fully healing in about 3 weeks +. I have two inguinal nodes on my left side that are still pretty big, one is 15/30 and one is 15 mm, they are regular shaped and they are intense vascularised hipoecogen. I made some investigation and i have Proteine C Reactive 3.8 and Leukocytes up to 127.000. In present I am also diagnosed with a balanopostite. The node reduced in it size visually, when it appeared first after the "possible herpes outbreak" being much bigger

[Ken_PA]

Yes, and ID doc is the way to go on this. Not an onc.

Looking at your panels:
you'd look more at LDH than hs-CRP for cancer. A CRP (inflammatory marker) from infection can go much, much higher than what you have.

Fibrinogen is high probably because of inflammation.

You leukocytes are only slightly high, so the infection peak has probably passed. With lymphocytes midrange, yet neutrophls are upper-normal, I'd guess that your infection was on the kind that neuts generally respond to:bacterial or maybe fungus.

Good luck, I hope you found out something at your ID visit.

[Mincumihai]

Seems i have some pus around one of the nodes. Will go tomorrow to a Infectionist Medic, or what's the name in English. I'm a bit relieved since i have pus it's almost sure it's an inflammatory process!

[Mincumihai]

Maybe the chancre i had wasnt herpes but this. I actually own a cat and it's sleeping with me. It ***** I can't find anywhere the article or the book about this.

http://www.ncbi.nlm.nih.gov/pubmed/18498339

[Mincumihai]

https://www.dropbox.com/s/i3ztbh5ob9ziqn6/12000770870.pdf this are the complete rusults. Remember i take antibiotics, antimicotics and antinflamatory

[Mincumihai]

https://www.dropbox.com/s/i3ztbh5ob9ziqn6/12000770870.pdf this are the complete rusults. Remember i take antibiotics, antimicotics and antinflamatory

[Ken_PA]

The odds are low that you have lymphoma or another cancer. The odds are high that everything is due to the herpes virus.

Do you have relatives with unusual immune reactions? That means autoimmunity, or severe reactions to bee-stings, or lots of allergies. Thing like that.

[Mincumihai]

I tought about a biopsy but that seems really painful .I am also under medication at the moment taking antimicotical, antibiotics and antinflamatory meds, maybe that's why they are that modified, I also did a blood test but the results didnt yet arrived.

[Ken_PA]

HI, I'll suggest again reading this thread which goes along the same path as you are beginning:
http://www.medhelp.org/posts/Leukemia--Lymphoma-/Swollen-Gland-in-Groin/show/1995156

The overall summary would be that you can undergo lots of worry and testing and arrive where you started: an atypical enlargement of an inguinal node due to a pathogen and also a not-ordinary reaction on your part.

Test? An LDH (detecting rapid cell turnover, as in cancer, but also it elevates from other causes) is typically done. And it's cheap, btw.

More specific? A greyscale ultrasound, but the tech and radiologist *must* be looking for node structure, not merely for size.

Then, a color doppler ultrasound looks for increased vascularization, which results when a cancer exudes biochemicals that actually demand an increase in artery supply - which the tumor needs to expand beyond a very small initial size. That's called 'angiogenesis', and there actually are Txs for cancer which are anti-angiogenic, such as the infamous thalidomide.

Forget CRP and hs-CRP. IIRC, CRP can go to 80 or so in infections, so that's not specific to cancer.

The ultimate is an excisional biopsy. which is not medically justified in your case. Is money no object for you? If so, and you have that done, then a pathologist can review slides and give you a definite "not cancer", if applicable. They might also discover the presence of inflammatory cells and fibroblasts, which produce the scar tissue.

That might be more info than you wanted.

So in short: get a greyscale sonogram. That's a close second to a biopsy. And kindly report back what you discover. Your feedback can help others. Good luck :)

[Mincumihai]

https://www.dropbox.com/s/wzmy3e51tazb8d2/12000770870.PDF

This is my urine test done today.

[Mincumihai]

Thanks again, I don't understand much from that site. I went today to redo some tests, what tests would you recommend me to do? What tests do you consider are the best to show. Reactive Proteine C from what i read in cases of cancer should be much bigger, while 3.8 is a sign of a posible infection. Could also this enlargment of the node itself be sign of a cancer located nearby or not?

I visited a bounch of medics in my town and none is capable of saying: you have this, or you have that.

Thanks for your time, i consider it a mental support!

[Ken_PA]

You might find this useful. Though it's topic is about cervical nodes, I don't know of a reason why the basics won't also apply to inguinal nodes:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2324368/

Also this thread from this very forum:

http://www.medhelp.org/posts/Leukemia--Lymphoma-/Swollen-Gland-in-Groin/show/1995156

[Ken_PA]

Yes, a malignant node can sometimes be painful if, e.g., it is necrotic at its center and there is bleeding into that center.

Did your scan mention the hilum?

I'm thinking that the increased vascularity (seen on color doppler sono?) can be from inflammation process.

At this point, everything provides only indications, and only a biopsy is definitive - but seeing a fatty hilum and normal structure almost always means not-cancer.

Nodes getting much larger would be worrying, while getting smaller is a great sign since lymphoma can wax and wane a bit but won't go down significantly.

You'd want some bad signs to counter the Law of Parsimony.

I'll look up a cite for you about sono and cancerous nodes...

[Mincumihai]

Thanks a lot for your fast reply. I will ask on that forum. The idea is that 2 days after this possible herpes appeared the node inflamed. I guess a cancerous node wouldnt grow over night that big and as you said it shouldnt be painfull, tough i read about not painfull lymph node that were malign.

[Ken_PA]

Hi, there's nothing much to indicate lymphoma here besides the 3cm dimension. Painful nodes are usually not cancerous, because instead of stretching the node from inside, the cancer just grows right through the enclosing capsule. Also, a node which gets scarred (fibrotic) will take a long time to go down, maybe that's what is going on with you.

I suggest asking on the herpes forum about your slightly unusual course of disease. Good luck.

[Mincumihai]

What would be your guess, i see you have a big experience in this? I am very worried:(

[Mincumihai]

I want also to add that the node, the visible one, is painful and it's hurting me, not much when laying on the bed, but a bit more on movement. I am worried because of the size and that from what I researeched usually Herpes adenopathies are smaller and usually tend to heal faster.