Is a 1x0.9x0.4 cm lymph node considered oval or round?

[Lewalt]

I've had a palpable lymph node in my neck for nearly 2 years that I know about. As far as I can tell by feeling it, there has been no growth. It's on the right side towards the back at my hairline. I had an ultrasound done 1.5 years after discovering it and all it says is that it looks like a lymph node and gave the size at 1x0.9x0.4 cm. I'm reading around the net and keep reading about round not being good and oval being good. But it seems mine is oval and good axis ratio in one direction, but round in the other. Is that abnormal shape?

It's hard to tell if it's fixed or not and if it's hard or not. It's definitely not freely moveable. It's embedded in other tissue and so it doesn't move around, but I can't tell if it's attached to other tissue or just sunken down among it. When I press on it to feel if it's hard, it sinks into my neck. It can't be grabbed as not enough of the node is above the surface. It's not visible and can't be felt when running my hand over it without applying pressure. But is easily felt as soon as I apply any pressure.

[Lewalt]

There was another part to the above post, but I included a link to another forum and didn't realize that wasn't allowed. It had info about how pred is known to mask lymphoma symptoms, including temporarily shrinking nodes, which can cause missed and delayed diagnosis.

I can now definitely feel the lump returning. Not large enough yet to have a doctor find or think is an issue, but I'm guessing it's going to end up back to where it was going on how I can now easily find it and wasn't able to just days ago. Have been off the pred for not quite a week.

[Lewalt]

Here's a portion of something I found:

Although steroids (prednisone) will cause the lymph nodes to decrease in size, regardless of the cause of the enlargement, it is strongly discouraged because it could mask a serious underlying cause of the enlarged nodes, delay the correct diagnosis, and, possibly, complicate the treatment.

[Lewalt]

I hate going down this rabbit hole of health anxiety.

I've been having abdominal aches and chest tightness/heaviness for a couple weeks now. The abdominal aches come and ago after a few days, but the chest issue remained. One night it got particularly worrisome as while I could breath, my passage seemed quite restricted. If it got any worse, I'd have been going to the ER. So while I was out the next day, although it had gotten somewhat better by morning, I stopped into an urgent care. They listened to it and said I had an upper respiratory infection and to take prednisone. So I am. Pretty quickly the lung issues improve and the abdominal ache starts back a little but then goes away quicker than usual. Now, I go to feel for the lymp node in my neck. The one that has been enlarged and palpable for 2 years. It's not there! Great news, right? Nope. The internet says no.

So I start researching this and get flooded with info about how pred can shrink lymphoma nodes and mess up tests for diagnosis. So there goes my plan to go get this checked out again anytime soon. What I couldn't find was how long I need to wait. I'll be on it for 10 days. This is just after two full days of dosage and the lump can no longer be found.

Of course, I find the perfect story to send me into a panic. A guy who had chest and abdominal pains and was put on prednisone. They cleared up right away. As well as other issues like some bone aches, which I have been mildly experiencing. Then 3 years later, it was later discovered these pains were from a large mass pressing against organs (what I fear my sensation are from) and the pred had been able to relieve the symptoms.

So while I'm starting to feel physically better and I no longer have a palpable node in my neck, I'm just as concerned, if not more, that I have lymphoma. And certainly more convinced that if I do, diagnosis will not be coming soon enough. It was impossible enough before. Now to have no lump. There's no chance I'll be taken seriously.

Everyone wants to tell me it's anxiety. The abdominal pains, I could buy being anxiety. But not the chest pains. There's something there. Some kind of infection or obstruction. Maybe it's just an infection and the pred will clear it up and that's it. Or maybe it's cancer induced and the pred will just mask the symptoms for a while. I guess now I just wait to see if symptoms start to return at some point. Including the node. If it comes back, I can't imagine that's good. My research was far from exhaustive, but I found nothing to indicate that pred would shrink reactive nodes that would later come back.

So it looks like getting the lung issue looked at might'e just really complicated things when it comes to my ultimate worry.

[Ken_PA]

Your experience pretty much proves that the bump is not cancer. Think about it: if cancer were so easy to shrink, there would be no need for devastating chemo drugs. The world would be filled with anecdotal accounts of near miraculous results from pred alone.

Corticosteroids can shrink inflammation incident in a lymphomatous node, but that's just a small shrinkage. Corticosteroids might also be a little bit cytotoxic, but not much.

So you've received an important clue as to the real underlying problem.

[Lewalt]

I believe I can now start to feel where the lump is again. It's not something I would've ever found if I wasn't looking and pushing in. So I don't know if I just didn't search enough when I first noticed it was gone or it has started to grow back now that I'm off the pred. If it stayed like it is, I wouldn't be concerned. It's not something a doctor would ever be able to feel. But if it grows back, I'll be concerned and go get it checked.

The lung issue is also still hanging around. I never had a cough or sinus issues or a fever. Just tightness in my upper chest and a sensation of something deep in my right chest area. I still have these feelings, but very lightly. Though, aside from a couple different days, it was never much more than this before and while I was on the pred. It just never seems to get better or worse or go away. And also I have an irritated feeling in my throat, like I;m going to get sick. But that's been going on for a couple weeks and I haven't gotten sick.

Basically I don't feel right and like there is something wrong, but there are never serious enough symptoms to make doctors think there is anything to look into. But I read story after story of cancer patients who say they had no other symptoms than just not feeling well or right for a while.

[Ken_PA]

Several more 3d measurements, they vary all over and some could presumably be regarded as rounded:

http://www.medhelp.org/user_photos/show/758300?personal_page_id=928161

It should be reassuring that an onc has pronounced this as likely not-cancer and doesn't want resectional biopsy:

http://www.medhelp.org/posts/Leukemia--Lymphoma-/panic-mode-RE--lymph-nodes-in-neck-no-fatty-Hela/show/2962500


I also wonder if a high frequency 2d sono has better resolution than a 3d sono, or not.

[Lewalt]

I think which stands out to me with mine is that the short axis measurement is at the end whereas all these other roundish ones appear to be in the middle. I still wonder if that's an issue with the order given or if mine is just shaped differently.

But yes, it does help to know that there are others with a roundish dimension which are being called likely reactive.

About my blood test (forgot to address in my above reply). My monocytes were low in both number and percentage and my lymphocytes were low in number but good in percentage. And while my WBC was within the normal range given, it was near the bottom of the range at 3.7 with the bottom being 3.5.

I did do some more researching this and found one other test where all my numbers would've been in range except my lymphocyte % being 2.9 instead of 3. Still, it's concerning to me that nearly everything in my WBC is near the very bottom or below normal. In a month, it'll be 6 months since the test. I think I'll wait until then and get another one for comparison.

My tests have WBC, RBC and platelet histograms at the bottom. Can those tell anything of use? No notes were written for them.

[Lewalt]

I must've overlooked the ovoid part when I first read it and just focussed on the size. Yes, it was frustrating researching this as like you said, I could find nothing covering the specific issue of 3D measurements indicating the node is oval as well as round. I did see some others who gave 3 measurements for their node, but nothing was ever said about the significance. Also, most of (if not all) of those examples with had two similar sized measurements, had the shortest one in the middle rather than 3rd as on mine. But I'm not sure if they were ordered in the same standard or not. All of those threads ended before any conclusion was given, so I don't know how they turned out.

I will make an effort to come back with any updates. But if it turns out bad, I could see not making my way back here. I always wonder what happened in all those threads with no conclusion. Many end with saying they are going to get their results. I figure most of the time it came back fine and so they went on with their life and never made their way back to give an update. But then I wonder how many may've gotten bad news and giving an update just wasn't a priority. One of the threads had it looking good for the person and then at the biopsy, the surgeon made indications it didn't look good. But then no update on the results.

My plan is to see an ENT to discuss this and get another blood test. I will see about getting a 2nd opinion on the ultrasound, but am not sure how to go about that. The clinic where I had it done (but was not read there) only gave me the paper I quoted when I requested the results. So I'll have to look into who actually has the imaging. I think I'll wait and see what the ENT says, though. Maybe they will want to do an update ultrasound to see if it grew.

After doing research and reading other people's ultrasound readings, mine seems more vague than all the ones I've seen online. Most readings I found were similar in length and structure, but included more specifies. Mine seems to not even want to confirm it's a lymph node. However, the woman doing the ultrasound said "Oh yeah, I can see it. A little lymph node" as she was asking me to point it out. Then the doctor giving me the results said it was a lymph node. I realize no one can really tell me anything for certain without a biopsy, but I wish I could've been told the true details of my results at the follow up. I would've liked to discuss the parts I have concern with. He didn't actually show me the results, he opened the folder and looked at them and then told me the lymph node is probably benign and that my blood results were all normal. However, after now requesting these results, I find out the numbers weren't all normal and nowhere in the ultrasound reading is it mentioned that that there was any opinion on whether it appeared benign or not. It doesn't even commit to being a lymph node. Had I known the actual results, I would've made it a point to continue investigating it by making an appointment with an ENT at that time.

This process has been very frustrating and reading of others who had similar experiences of being told "It's probably nothing" and then later diagnosed with cancer is what has me worried. Most of the stories I read have included larger size nodes and/or multiple palpable nodes and/or prominent symptoms. Then I start to feel a bit better and think it must not be anything after this much time has passed and no noticeable increase in size or obvious symptoms (I never have a fever when I check and noticeable sweating at night only occurs when I use a heavy comforter on my foam mattress). Then I read a couple stories of people who had tiny lumps in their neck for 2 years with no other symptoms and were told it was probably nothing until later being diagnosed with cancer that had spread. Now my biggest fear is not just that it is cancer, but that it has been let go this long.

I have never heard about the allergy and anxiety connection. I will read up on it. Both are pretty severe for me, so I wouldn't be surprised if it's somehow connected.

Thanks again for replying to my posts.

[Ken_PA]

Well, you're very thorough, which is an advantage. But it also takes a while to really coalesce all the quickly acquired knowledge.

Some rapid fire thoughts:

In a study, out of all the people who had enlarged nodes long enough to have made them seek a doctor, only 2% had a cancer.

"After doing research and reading other people's ultrasound readings, mine seems more vague than all the ones I've seen online."
Yep, as if being mass produced med care. However, it's also probably true that there is less to see in smaller nodes.

When "night sweats" are a symptom, that means being drenched so you have to change clothes.

About low monocytes; low cell counts from a blood cancer occur when the cancer cells invade the marrow and crowd out production. It would be very unlikely that somehow *only* monocyte production was crowded out.

You have hit on the thought that seems to have no logical counter: a person might have an early stage of cancer that hasn't resulted in large enough nodes *yet* to concern doctors. But here is a counter: if you do have lymphoma, which most likely you don't, it would probably be a very indolent Follicular lymphoma. In that case, you probably wouldn't get treatment anyway and only be put on "watch and wait". So it's not as if you are necessarily missing out on a crucial treatment window.

"Then I read a couple stories of people who had tiny lumps in their neck for 2 years with no other symptoms and were told it was probably nothing until later being diagnosed with cancer that had spread."
But that is really rare and so then a person could also worry that having a CT scan to look for a cancer can actually cause a cancer, or a biopsy could spread a cancer - so it was really better to do nothing.

If it was me, I'd instead direct the brain power into researching and implementing non-pharmaceutical anti-inflammatory strategies and any possible immune boosting strategies. I don't mean to be sounding argumentative here. When I was taking care of my father with lymphoma, I adopted the approach of being completely aware of the worst but forcing myself to believe the best.

If I've missed replying to something important, let me know.

[Lewalt]

Yeah, I kinda had the "mass produced healthcare" type feeling as well. There were no notes written in any of the notes sections of the blood results. Including the flag notes section, even though there were 3 flags.

I was feeling better reading about how the night sweats are drenching, as I've never had that. But then I always read too much and find a couple people who said they just sweated a bit off/on and had no other symptoms.

My anxiety has been my enemy all my life and it doesn't help with this. I am an extreme worrier, so I get to the point of really obsessing over this lump and symptoms that could possibly be connected. But I also have extreme social anxiety and don't leave the house much. So going to the doctor is tough. Usually I get to the point of such extreme worry that I force myself to go. That's why it's so frustrating for me to finally get myself there and then kinda be dismissed. And also, I can never know if the crappy way I feel is because of the anxiety increasing over the lump or if I do have a physical illness possibly related to the lump.

My anxiety is very good at supporting my worries with logic. And that's a good point about the indolent possibility and something I had considered. But then the other worry I came up with is that it's not lymphoma, but a cancerous tumor somewhere else and has caused this lymph node to enlarge but not keep growing. Possibly having enlarged other lymph nodes I can't feel. I was having chest and abdominal issues this past week, which were starting to concern me in this way (but also as they are lymphoma symptoms). The abdominal issues have cleared up and the chest issue is much better. Both could be easily explained by my anxiety and allergies. But I still always wonder if it's really that simple.

What sent me to the doctor a few months ago to finally force the issue of having it looked at in some way was a rash. I started getting an itchy rash of dots on my belly, which then just kept spreading onto my legs, arms, chest, neck. All of these places could not have been in contact with the same allergen. So I start researching if there is a rash-lymphoma link and of course there is. So I start researching the details and find pictures of severe rashes that look way worse than mine and skin tumors, etc. But then I find the couple people who say they had dot rashes come and go for years before being diagnosed with lymphoma. I was sure then that I had it. For about 2 weeks it just kept slowly spreading. Sometimes a couple dots a day. Even as the earlier ones healed up, I was getting more. Finally new ones stopped popping up and they all eventually healed. I still don't know what it was and had no itching or rashes since.

No, you don't sound argumentative. I appreciate the input and you trying to put it into perspective without being dismissive. I wish I could get a doctor to give me that kind of attention and time for my concern.

I realize that the odds are greatly against this being cancer, given all the details we know, but that's where the obsessive anxiety comes in. That small percentage which makes it still possible. So in my mind, it becomes either I have it or I don't.

I read about your dad in your profile. Sorry for your loss.

I'm just kinda rambling now, so don't worry about replying to everything. It's just nice to discuss it with someone who has some knowledge and isn't dismissive.

[Lewalt]

Here's the full text of the ultrasound reading I was given.

There is a subcutaneous ovoid density beneath the chin on the right side of the neck. This measures 1cm by 0.9 by 0.4cm. It is hypoechoic with hyperechoic changes in the mid part of the nodule. This may represent a lymph node.

IMPRESSION:
1. This sonogram confirms a subcutaneous nodule of the lateral right neck.
2. This has the appearance of a lymph node.
3. May consider a follow up study if needed.

[Ken_PA]

Well, that's that then, since there's no reason to disregard what the radiologist says about it being classified as ovoid. Maybe they just take the ratio of the longest measurement over the shortest.

Measurement of nodes is not a cut and dry subject. I even recall one study describing how nodes tend to be bigger in Brazil for some unknown reason.

I can see now the frustration you must have encountered in researching your question, since I've looked and encountered thousands and thousands and thousands of words written -- without anyone even once addressing the point.


As to your main concern, I don't think that being round should create alarm when the node is small and hasn't grown. It could just be a fibrotic node (and we don't even know for sure that it is a node), where some internal scarring has occurred and that can take a very very long time to go down.

It's not homogenous, either, with the center being different which AFAIK suggests the presence of the hilum. So that tends against cancer -- wherein all the cells are the same and everything is homogenous.

You can probably also ask for a 2nd opinion from another radiologist on the same images. Let me know if you do. It would sure seem that the node is round, else that would be really one funny looking node if it were still bean shaped when looking from above but had somehow grown to be twice as thick -- like two lima beans stacked on top of each other.

If you get a simple CBC and monocytes are back in normal range, that settles that, too. You can even do that today on your own for ~$35.


Speaking of allergies and anxiety, did you know that histamine is also a neurotransmitter, and that the antihistamine Benadryl was the basis for developing Prozac? So I personally think the two conditions can be related.

[Lewalt]

Thanks for the reply, Ken. Its size as far as I can tell hasn't changed in nearly 2 years, but since I can't feel the whole thing, I guess I can't be sure. I'll see about getting an appointment with an ENT to look at it and discuss the test results. The roundness and low numbers on my blood test are what concern me. Also that it feels like it's probably attached to tissue.

I have some mild symptoms- most come and go, but nothing which couldn't easily be blamed on my allergy, depression and anxiety issues. The doctor didn't seem concerned, but he's someone I've only been to once and he was rushed that day and now that I requested my results, I find out that my numbers weren't all normal. He said I could have an ENT look at it if I like. I had some other things in life come up and getting to an ENT didn't happen. That was about 5 months ago.

[Ken_PA]

Sorry, I see that you say it's the back hairline. Anyway, that introduces the concept that some nodes (also parotids) are naturally more rounded. Most everything has to do with "tending".

Most sonographic measurements are given as 2D. IIRC, the order of measurements in 3D scanning is front to back, then side to side, then head to foot directions. But then for neck sono, the nodes are near the surface and conventions might be different, so the 0.4 cm is probably the thickness/depth of the node. If that is correct and your node thereby is round, then you'd be most interested in any increase in size.

Btw, most docs aren't concerned when a lab value is only slightly out of range. That said, to me the monocytes seem more than slightly low - but occasionally having low monocytes is not uncommon. You'd be concerned if it was a long term pattern.

[Ken_PA]

Is it a submandibular node? They tend to roundness normally.

[Lewalt]

Btw, I'm 37. Also, my doctor did a blood test and when I had the follow up, he was looking at my results and saying to himself as he read each of the first few categories "normal, normal, normal, normal. Everything's normal."

However, I just recently requested the results for myself and there are 3 listed as abnormal:

LYM# 1.1 (1.2 - 3.2)

MON% 2.9 (4 -10)

MON# 0.1 (0.3 - 0.8)