Swollen Gland in Groin

[needadvice1911]

In late early July 2013 i was diagnosed with Epididymitis.  I te4sted negative for major bacterial causes.  The doctor suspects a viral infection of some sort.  I was told to wait it out.  I went to walk in clinic three weeks later as i began getting a pain in my goin on the right side.  It seemed to stick out a little more than the left.  The doctor said it could be hernia or a swollen lymph node which would make more sense with a genital infection present.  He sent me for an ultrasound to confirm the lump.  It was  confirmed a swollen lymph node:  "mildly enlarged right goin lymph node corresponding to the area of tenderness with mostly benign features likely reactive and of questionable significance."  it measure 19.3mm x 11.1mm x 5.7mm.  My issue is that it is a month past that that diagnosis.  I can't tell if the lump is any bigger, but i do know the pain has not gone away and slightly increased.  Pain spreads to my upper right thiigh, right buttock, right lower back and kidney area.  In early july i had my annual physical and my blood work came back clean.  nothing unusual our outstanding.  My concern is lymphoma.  Can anyone please comment.  I have an appointment with my doctor tomorrow to review the pain i have in my groin and thigh.

[kosh33]

Hi, I am reading your posts because I have a very similar problem with a very similar doc responce. My lymphnodes are not painful to touch and the right side one feels the size of a large kidney bean and sometimes goes down or up in size. And the ache I have comes from the lymphnode area while the actual lymphnodes are not painful to touch. Were your lymphnodes painful to touch or just an ache behind them? Did the doctors ever diagnose the problem causing it? My CT scan showed unenlarged nodes and benign, but they feel enlarged to me and the doc is thinking to order another CT scan. How large were your lymphnodes?
Thank you and I hope you are doing well

[Ken_PA]

Hi, can you post the report from your CT scan?

[viking77]

Oki. Is good you are better.  God bless ;-)

[needadvice1911]

I'm doing well now.  I have other concerns that are not related to a lymph nde issue.  after numerous scans and other investigations, nothing wrong can be found.  I'm not comfortable from time to time, but all is well for me.  Trust your doctors, but keep on top of them.  

[viking77]

Hello there. I have similar issue. Right groin pain for 7 months with lymphocytes going up and down. How are you now? Ken.. I am amazed by your knowledge,  compassion and the time you give helping out. You seem very wise and logical in your answers.  Hope to hear from you

[needadvice1911]

Thank you so much for everything.  The support from yourself and this forum means a lot.  Merry Christmas to you and yours!!!!!!!!!!!

[Ken_PA]

Well, that's good news for you again. The architecture of the node seems good. The spot didn't enlarge from pressure while doing the Valsalva Maneuver, so that argues against hernia.

It's very helpful that you provided such detail.

Think of it this way: a cancer that was so aggressive that the node enlarged so very quickly wouldn't then turn into a slow-growing kind. Yet the size has not only stopped increasing, but also deceased a little. (I'd think it will take a long, long time for macrophages to further whittle away the scar tissue.)

Next visit, you can emphasize the pain if you want it removed. But it seems to still be doing it's necessary job - and there is always the chance that the surgery might not go perfectly (e.g., you can end up with a lymphocoele.)

So, you don't have lymphoma. I hope you put the worry out of your mind for a while and have a Merry Christmas :)

[needadvice1911]

I just came back from the doctor.  He walked me through my blood work, explained the levels and all mine were normal.  Second we went over sonogram results from October 17.  Liver, Billary Tree, gallbladder, spleen, kidneys, pancreas, aorta, IVC, all normal.  Groin sonogram results as follows:
Rest:  No peritoneal Contents.
Valsalva:  No change in the appearance of soft tissue.
Additional Comments:  well defined hypo and hyperecholic masses anterior to the neurovascular bundle with thin cortical mantles as follows:  Right - 16.3mm x 11.7mm x 3.3mm and 11.1mm x 11.0mm x 4.0mm.  Left - 10.3mm x 8.8mm x 4.0mm.
Interpretation - 1) Normal Studies.  2) Normal appearing bilateral groin lymph nodes likely of no clinical significance.  3)no sonographic evidence of  a groin hernia.

So, those are the results.  My doctor says that because the enlarged node on the right is next to a bunch of nerves and presses against them causing my pain/discomfort up and down my right side.  The second node on the right was measured against a node on the left to say they are similar in size and normal.  I asked him if I had lymphoma and he said based on these results he would have to say no.  He also mentioned that the node is a bit smaller now than it was in july.  He suggests to give it time to go down.  if it does not in a few months, he would not oppose removing it to relieve pressure on the nerves.  What are your thoughts?  Does this seem accurate to you?

[Ken_PA]

That depends on the diameter, I suppose - and needs the doc there in person.

I once saw an N.P say he could feel an enlarged spleen or any other organ. I'd think that would be lots easier with slack abdominal muscles.

Good luck with your appointment.

[needadvice1911]

I would say below the muscle wall. Just to the right if my belly button.   Could the liver do that? I will check with the doc. Thanks

[Ken_PA]

My guess is that a sono can only look so deep, then you need a CT or MRI.

There are nodes all over there, close to the surface and/or deep ones. But an enlarged node would have to be really big to make that protrusion. Is it above or below the muscle wall? Maybe your liver if underneath.

[needadvice1911]

Hey ken. I hope all is well.  I'm feeling good however still have some unanswered questions. I have an appointment December 4 to ask a few things.  One question I have is since I had a full abdominal ultra sound, would that show lymph nodes that are enlarged in my abdomen area.  I ask this because the right side of my belly beside the belly bottom sticks out further than the left side.  I know it may sound odd but could enlarged nodes do that or are they too deep to make that happen?  

[Ken_PA]

Hi, we just crossed postings.

I don't think (i.e., guess) that prostate cancer is causing your symptoms, no. It's doesn't fit with metastasis, and besides your node increased size very quickly like infection. Your age also doesn't fit. A prostate cancer group would be the place to ask, though.

Sorry to hear about your dad. Prostate cancer can be very slow growing, so there is a move toward not treating it unless really necessary. Sometimes not at all.

Have you tried anti-inflammatories for yourself? I'd even try lots of ginger and turmeric - which might be a good lifelong habit to start.

[Ken_PA]

Hi, because of your scan, you can feel confident that you don't have lymphoma.

You can look up how internal scarring (fibrosis) can make nodes not go back down. You probably don;t have a chronic or recurrent infection. One other possibility is having granulomas in the node - maybe that's thee least likely, though.

If you complain about bad pain there that would tend to increase your chances of getting it surgically removed.

[needadvice1911]

I hope all is well.  Sadly, I just found out my dad was diagnosed with prostate cancer.  Its been a bad week for us.  Doing all the scans to see if there is any progression.  Glad I did a PSA test a few weeks ago.  Doc said it was OK but now more than ever I want the results.  Never knew this before i asked for the workup.  I know its silly to ask, but can my prostate be causing the issues/feelings i'm having?  The enlarged node, intermittent pain through my hip, thigh, and flank?  my original ultrasound did say my prostate was at the upper limit of normal size.  I guess I'm just grasping for answers now.  After finding cancer in your family, you don't want to leave any stone un turned.

[Jellybean1986]

I don't have any advice. I just want to say that I also have a lot of anxiety surrounding lymph nodes and my current medical issue. I have been dismissed by one doctor only to be told by a second doctor that he knew exactly what was wrong a few times in my life (gallbladder, cysts, precancer which was resolved and a prolapse that 3 GYNs missed)

Because my blood pressure is causing me to be home from work for awhile I have been trying not to "google" things and figure it out. It's easy to get really worked up.

I hope you get your answer to the bulge and pain soon!!

[needadvice1911]

So I waited two weeks after mt scan to call my doc. His policy is he only calls if there is something negative to talk about. I call the office and he called me back. He said there was nothing alarming or abnormal with the scan. All blood and urine was normal. Even did a PSA test.  I have an appointment December 4, 2013 for blood work.  I have high cholesterol and get checked every six months. On this day I will get a copy of the scan summary. This does make me feel better a bit but to be honest I still feel the fullness and pressure in the groin. The node is still bothersome. If you were me, would you feel more confident with the results I've had to date?

[Ken_PA]

That's because a person might have gotten some pathogen (parasite, bacteria, fungus, virus) that a doctor in Canada wouldn't think of offhand. Meanwhile, a doctor in Mexico might say that they see similar medical conditions a lot.

You started by saying that "I tested negative for major bacterial causes." But that would presumably be referring to bacteria typically found in Canada. The same goes for parasites, etc. You also might have met someone in Mexico who had just returned from anywhere, like Thailand. (On the flip side, a doctor in Thailand might not think of Lyme for his patients.)

Is two weeks too long for latency of an infection? I don't now, but doctors in Mexico or Thailand might know. Hopefully, your doc knows about the travel.

[needadvice1911]

Thanks again.  I will share the results as soon as I have them.  Just out of curiosity though, why do you mention exotic locals?  This whole mess began just a couple weeks after I returned from Mexico.

[Ken_PA]

Some techs break the rules and give you info, others just won't. Some will even point out to you on the screen what features they are seeing.

I wouldn't be surprised if you have some enlarged nodes in the abdomen. But that doesn't tell anything about why they are there - so don't get worried if any are on the report, unless there are very many of them or if there is one or more that are very large, like over an inch.

For the groin sono, you want to see terms like "reactive" or "normal architecture" or "especially "fatty hilum is present". Even if the node doesn't have normal architecture, you can still hope that you have 'inflammatory pseudotumor'.

My guess is still that you have a very reactive immune system which is producing atypical reactions. That's if you weren't travelling in any exotic locales, and haven't been around someone else who has.  

If the node continually causes pain and other adverse effects, then you might have justification for getting it removed. Otherwise that node has a job to do and so it shouldn't be removed without good cause.

It'll be interesting to hear the result of your sonos.

[needadvice1911]

thanks for the advice.  I opted out of the CT for now.  I will reschedule if needed after my doc and I go over the Sono results.  I asked the sono guy what he saw and how it looked.  He joked saying it was top secret and classified.  He couldn't tell me anything.  Looks like i'm waiting in suspense for now.  He did press firmly as he moved the wand over the bump in the groin to show me where it was.  He said, "feel that right there?  That is the node."  Its right long the crease between the thigh and groin.  I was not able to feel it before.  Didn't seem to big to me, but he's the one with the measurements.  He said my doc should have the results today or tomorrow.  I got a full abdomen sono done as well.  those results take longer to put together, but the guy said my groin results (which are of more interest to me) should be with my doc very quickly.

[Ken_PA]

You know, before getting all the radiation for a an extensive CT. I'd maybe ask for a needle biopsy. Usually, that's to look for cancer cells but here I'd think maybe there might be useful info in seeing what unusual but non-cancer cells might be in there. Maybe lots of esosinophils, just as a shot in the dark. Or maybe a total lack of fibroblasts, which could mean that scarring is not a big factor.

Even just seeing the color of any fluid around the node area could be a clue, without needing lab analysis.

Btw, I'd ask the sono tech what they see. Sometimes, some of them give info, and so you don't have to wait in suspense.

[needadvice1911]

An update to my never ending story.  I went back to the doctor a week ago.  i discussed the possibility of a blocked node.  The doc (a new one now) was open to the thought.  He did full blood/urine work.  All came back normal.  Even did PSA to check the prostate.  tomorrow morning I go for another ultrasound of the groin to check if node has changed in shape/size/content/etc..  as well as a CT scan to see if there is additional growth anywhere else in my body.  New doctor as well does not seem all too concerned about lymphoma, but he does take my concern seriously and wants to get to the bottom of this so i am pleased about that.  I will post my results of the scans next week.  They take 3-5 days to come in.

[Ken_PA]

I'm glad to have been of some help. I think the only remaining mystery revolves around what the initial infection was.

I just had another thought: It's also possible that the lymph system in that inguinal node of yours is blocked because in fibrous tissue. That makes lymphatic fluid back up (called a lymphocele) and can result in increased size. After all, 1.9cm is pretty big and is at the upper limit of what a benign node can be. Getting periodically more backed up can explain why sometimes your pain gets worse. Maybe your doc can drain it just by inserting a hypodermic needle and pulling back on the plunger. That's not an unusual procedure. You know, that might be the best idea here.

[needadvice1911]

Thank you Ken for coming along with me through my journey.  it's a good feeling knowing someone is listening.  it's hard to talk to family and friends about this.  I will continue to see if there is any improvement and/or change in my condition.  It's the unknown that is the worst.  More and more people I talk to about this issue i'm having all seem to be steering me away form lymphoma.  I will ask my doctor about the possibilities you suggested and see if there is any way to verify.

Thank you again.