My 13 year old has swollen left clavicle lymph node

[NEmomneedsopinion]

My 13 year old daughter noticed a lump abover her left clavicle in July. In Aug I had her pediatrician look at it and after reviewing any other causes (illnesses/injury) and checking for other swollenn lymph nodes (there were none), she sent us for lab work.  All was fine, although I was a little concerned that her Immature Granulocytes No was high .04 (range 0.00-0.03) and her Immature Granulocytes was 0.5 (range 0.0-0.5) which is on the higher end. Her sed rate was on the high end of her range as well 17 w/ a range (1-20) with no obvious illness. The lymph node was measured in Aug at 1.0cm by the pediatrician and did not seem to grow over the weeks we watched it.  In October, we had an xray -all was fine. The lymph node at this point did not seem to be growing but was not going away - it is non painful most of the time, occasionaly hard but for the most part, just semi firmish.  My daughter then had an ultrasound and the lymph node was measured at 2.6 with another enlarged lymph node next to it. We met with a surgeon knowing the known lymph node was coming out, but was informed he wants to grab the other one as well.  I realize for children, odds are that she is/ will be fine but I would like an opinion from someone who does not know my daughter or myself and therefore would not feel bad laying out what the chances are of this being a lymphoma.  thank you!!

[Ken_PA]

Hi, the removed node sounds like the one called "Virchow's node" (left supraclavicular). It's very important because it is sort of like the last stop in the lymph drainage system for a large part of the body. It's a very worrisome spot to have a swollen node, especially when they are very hard.

Imagine the spot where a river drains into the ocean. Imagine also that at that spot there is a big filtering screen across the river, so that all the water must pass through it. Whatever you find in that screen gives you an idea about whatever was upstream, where the water flow originated. In this case, the main upstream area to wonder about would be in the abdominal cavity.

The super good news is that node was removed and it is not cancer. I'd suggest getting a copy of the pathology report on that node, to see what clues are in there - especially as to what, if anything, looked abnormal.

So what is now causing other nodes in the vicinity to enlarge? At this point the likely remaining suspect is some infection - bacterial or viral or even fungal. Lack of fever might point most to a virus. The infection is hidden ("occult") because it's not serious enough at this point to create noticeable symptoms like pain or swelling. But the inflammatory chemicals from the deep infection can clause the downstream supraclavicular nodes to swell.

I'd guess the purpose of the upcoming MRI is to look around and see what there is to see in the abdominal cavity - unless they are going to specifically MRI that newly swollen node. Or both.

As far as the "intermittent swelling in areas around her neck and chest on the left side", that might be because of the removal of the first node. The normal drainage of the lymphatic fluid can get backed up and cause swelling/edema. I'd ask the surgeon if that's true.

All in all, the worst (cancer) has not been true for her so that's something to be relieved about. Good luck.

[NEmomneedsopinion]

I would like to post an update - My daughter had surgery in Dec 11 to remove the lymph node(s).  Incision is all closed and healed and she is has gotten back most of the feeling that she lost from the surgeon digging around in there.  About a week ago, my daughter found another lump and she has been having intermittent swelling in areas around her neck and chest on the left side. We went to the doctor and he measure what felt like another lymph node  to be 1.25cm . My daughter has not been sick.  

Any ideas as to what the issue still is?  Her surgeon wants to see her again and he was talking about scheduling and MRI.  
I am at a loss as to what could be causing this?  Anyone have any thoughts????

Thanks for reading!  

[Mochadelicious]

Hi there and welcome.  Sorry to hear about all you've been through with your daughter so far.  You must be very worried.  I can tell you that most people who have swollen nodes have some sort of infection brewing and it is highly unlikely it's lymphoma.  She also has her age on her side.  70% of people who develope lymphoma are age 50 or older.

The only way to know for sure if it's lymphoma is with a biopsy, which is good that she's having one so the doctor's can hopefully rule it out.  Any other symptoms of lymphoma?  Fevers, nights sweats or severe weight loss?  You don't have to have these symptoms to actually have lymphoma, but some people do depending how aggressive the disease is.   And, even though some of her lab values are a tad high, I don't think they're high enough to cause concern.