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Swollen inguinal lymph nodes
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Swollen inguinal lymph nodes

Hi!

I am 25 years old girl. A week before I notice a little bump in my groin. I am quite sure it is a swollen lymph node. It is 2cm x 0.6 cm in size. In some position you almost can not see if you dont touch the area. It is very mobile, and firm but not very hard. It is painless.

The thing is that a week before notice this bump, I have some irritation in the area, because I was wearing very tight underwear for several days /weeks. Also I shaved the area few days before noticing the bump.

In a week the bump doesn't seem to shrink significantly. Should I be worried or should I wait more? As I were quite worried I was touching the bump a lot.

Could this be a shotty node? How long does it need to shrink? This could be consider as normal?

THANK YOU SO MUCH
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1081992_tn?1389907237
It's probably a normal reaction to some pathogen/infection - not cancer. It seems to be close to maximum size for a reactive node. "Reactive" means that immune cells inside are multiplying (a lot) in order to do their normal job.

I would wait to see if it goes down. Sometimes a node even gets scarred (fibrosis) from internal inflammatory processes and doesn't go down because the scarring remains.

You can sometimes do a quick check for more nodes in the same area but also at neck and underarms -- otherwise I wouldn't waste mental energy in worry.

11 Comments Post a Comment
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1081992_tn?1389907237
It's probably a normal reaction to some pathogen/infection - not cancer. It seems to be close to maximum size for a reactive node. "Reactive" means that immune cells inside are multiplying (a lot) in order to do their normal job.

I would wait to see if it goes down. Sometimes a node even gets scarred (fibrosis) from internal inflammatory processes and doesn't go down because the scarring remains.

You can sometimes do a quick check for more nodes in the same area but also at neck and underarms -- otherwise I wouldn't waste mental energy in worry.

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Avatar_f_tn
Thank you so much for your response Ken_PA!

I have been reading a lot on the internet about the normal size of lymphs nodes, and I find this is a quite confuising field. Perhaps any of you can shed some light on this aspect.

To me (acording to what i have reead) the normal size (meaning the 'natural' size of the lymph nodes) can vary from 0.5 to 2 cm. Being more large the inguinal ones.

It is considered that if a node is over 1 cm it is swollen (this doesn't mean cancer just means that it is 'reacting' to some process). In case of the inguinal nodes is up to 2 cm.

Do you agree with this?

Another controversial thing, is that while reading some medical researhing papers they say that the size of the node must be measured with the short-axis. This will implies that the limit of 1 or 1.5 referes to the short-axis of the node and note the maximum one. In some other web pages doesn't seem to say the same or it is not clear.

I would like to know your opinion. Also helping other people to understand this issue.

Thank you again (Ken_PA) and all the community
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1081992_tn?1389907237
Hi, for starters I'd think that what you are measuring by touch or sight would be different than an accurate measurement by a CT. That said, I myself haven't thought that the size of nodes is crucial unless the size is so big that it cannot be benign.

Would someone over 6' have the same parameters as someone 5' tall? How much inter-subject variability is in the paper you mention? (Btw, could you post the URL to that paper you refer to?)

Shape is also a factor. A node is generally bean shaped. Since there are many lymphatic vessels entering a node but only one exiting, then you probably can see why the shape is bean-shaped almost by necessity. Still, submandibular nodes are generally more round, so that's not a hard and fast rule.

Now, if an enlarged node is very long and thin, then that argues against being reactive since a reactive node tends to expand equally in all directions. (That's also why I cautioned about relying on informal measurements, so you don't think that necessarily applies to you.) Or a malignant node might be irregularly shaped, as if with extending lobes. Or it might appear divided. Still, these attributes are mostly suggestive and are not definitive.

You might like these two guides for clinicians:
http://www.aafp.org/afp/1998/1015/p1313.html
http://www.aafp.org/afp/2002/1201/p2103.html

One of them refers to a study that went like this: out of every 100 patients who had enlarged nodes long enough to go to a doctor, only 4 were sent for biopsy of which 2 had a malignancy. That gives an idea of the odds that what you have is not much to worry about: 98% non-malignant.

If the enlargement persists then you might want to delve into the causes behind that.

I hope that helps.



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1081992_tn?1389907237
You might want to mark the length of each axis as carefully as possible with ink. That way, if/when the node begins to shrink, you can be more objective in evaluating the change.
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Avatar_f_tn
Thank you Ken_PA for your explanation. I am not a doctor, but I completely agree with what you said.

We have to be careful when considering the size of a node. Because as you said is different what you feel, from what the CT scan said. Actually, as I told you, in my case, the node is not very noticiable over the skin surface, and the measure depends also on your position, height, age ...etc.

As you said the shape seem to be also important, is more suspicious when the long axis is similar to the short axis. Because, as you comment, they should enlarge more or less equally and the original form is similar to a beam (not in every area). Here is the paper in which this is breafly explain:  

http://www.medfak.ni.ac.rs/Acta%20facultatis/2011/1-2011/2.pdf

The paper you ask me for, about the measure in the short axis is the following:

http://radres.ucsd.edu/Education/journal_club/RECIST%201_1%20nodes.pdf

Just copy two parts of this paper:

"
Additionally, the imaging literature recommends that
lymph nodes be measured in the short axis, since the short axis measurement is a more reproducible measurement and predictive of malignancy.
"

&

"
To be considered pathologically enlarged and
measurable, a lymph node must be at least 15 mm in short
axis when assessed by CT scan
"

Thank you for your help. Tomorrow I will go to the GP, just to confirm it is nothing very worrisome (cross my fingers). I will keep you track.

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Avatar_f_tn
PD: I put beam instead of bean. Sorry to native english speakers if there is some other mistakes. ;)
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1081992_tn?1389907237
Menganita, thanks for posting the links to the 2 reviews.

So, you seem to be in good condition on the overall size, on the short axis and also on the shape (ratio).

Good luck with your appointment, I guess that the doc will say that there is nothing to worry over - but you might get an antibiotic and be told to watch to see if it gets much larger then come back.

Yes, please post here on the results of your visit.

Some docs are more aggressive on diagnosis and might order a sonogram if it doesn't go down fast enough.  If so, there are some other papers to possibly look over.
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Avatar_f_tn
Hi Ken_PA,

On Friday I went to the GP (primary care). I told him about some irritation in my skin previous weeks due to my underwear and shaving of that area. He told me that this of course could be the reason for my swollen inguinal node.

He then touch the node, and said 'it is a 1 cm mobile node, nothing to worry'. It is courious because as I told you is more or less 2cmx1cm...is very similiar to a bean. I guess he was thinking in the diameter or something like that.

He said 'Just forget about it'. He said to come back in a month or so and then we will take a look.  He also add, 'if the node was very big or if it was fixed then we will start to worry, but that is not your case.'

Also he told me ' the most important thing is NOT TO TOUCH the node'. I then confess, that as I have been quite worried I have been toching it everyday.

I confess that my fault was looking in Internet 'swollen lypmh node' and that scared myself. For me is now difficult not to look at it everyday.

How long do you think can it take the node to shrink? Should I just relax and worry if it gets bigger?

Thank very much you for your kind attention.
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1081992_tn?1389907237
Hi, M, I think that's good advice: "just relax and worry [only] if it gets bigger".

How long to shrink? I suppose that might vary by individual - and depends if factors making it stay up (touching it, or if some infection is continuing) are still present.

Don't forget about possible scarring. Scarring does not equal cancer :)

Thank you for posting the update. Most people just disappear.

P.S. You might discover through the years that you have a very active immune system. Did you know that histamine (an immune chemical) is also a neurotransmitter that is associated with intense personality types...
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Avatar_f_tn
Hi Ken_Pa!

Thank you so much again for your answer. I have an update in mi case, and I will told you, and also for helping other people if they have the same problem.

Today I have my rutine revision with the dermatologist (to check my moles). I tell him about the lump in my groin, and that the GP told me it was a swollen lymph node. He touch the bump and said 'That is not a swollen lymph node, that is a blocked sweat gland o hidradenitis'. He said 'it is too superficial to be a lymph node'.

I said 'Are you sure? my GP told me it is a swollen lymph node'. And he answered 'Yes, I am sure. Just forget about it. It will take a long time to go away'.

So I have two different opinions, but I think I have to belive the doctor who is specialized in this things, because GP has a very general knowledge I guess. Don't you think?

Well just let you all know that when thinking about a adenopathy you have to consider other posible diagnosis. In my case I was pretty sure that it was a swollen lymph grand and in the end perhaps is a blocked sweat gland.

Thank you for all your comments. Whish you the best. ;)
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1081992_tn?1389907237
It's funny that you mention this result, Fulanita, because in the past I would often mention here the possibility of sebaceous cyst (or even lipoma). Well, sebaceous cyst seems similar but is instead usually in a hair follicle.

Yes, I agree with you that the diagnosis of hidradenitis seems to be the most  reasonable given the circumstances. Not the suppurative kind, of which there are many pictures online. I will remember the term :)  

Speaking of moles, there is the possibility that over-the-counter supplements DHEA or pregnenolone might be useful if one seems to be turning bad.  I don't usually think that supplements help anything, but in this case I know it to be true. A nutrition writer named Ray Peat talks about this,

I suppose you'll be entering medical school soon :)
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