Ultrasound results for inguinal lump

[cerisecyan]

Hi,
My husband was sent for an ultrasound after I finally convinced him to get a groin lump examined. He has had it for around 15 years, since his late teens. He estimates that it has probably quadrupled in size since when he first noticed it. Due to a childhood history of having lumps in his back, he did not give it much thought. After finding out his family carries the brca1 mutation, I was doing research on what if any consequence that could have for males and ended up reading about lymphoma. Between the lymph node looking lump, his having had mono, and random things such as weight loss for no reason, skin rashes upon contact, and night sweats, I thought he should see a doctor for the first time in his adult life (for non emergency reasons, that is). His blood tests results were normal.

So, the ultrasound findings:
Hypoechoic nodule measuring 2.4x1.4x4.9cm
No evidence for increased vascularity
Nodule is well defined and does not extend into deep soft tissues or adjacent muscles
This may represent a lymph node or possibly a well-defined soft tissue tumor. Excisional biopsy is suggested.


I guess I had thought the US would at least show whether it was a lymph node but I guess not. Do those results mean anyone to anyone here? His primary care physician only received the results for his other unrelated scan - we picked this one up today, so we have to wait until Monday to speak to the doctor.

[Ken_PA]

Hi, did that surgery happen yet?

[cerisecyan]

Surgeon offered no information other than it should be removed so I asked a few rushed questions. He not look at ultrasound. It is unlikely to be lymph node bc would be deeper if that large. Likely to be lipoma. Surgery scheduled for next week. I'm nervous in general about surgery - unfamiliar with the process so hoping we are not making mistakes with decisions - but feeling slightly relieved after getting an explanation.

Thank you for providing useful information and support.

[Ken_PA]

Thanks for the update.

[cerisecyan]

The radiologist will only speak to the prescribing doctor.

If the surgeon does not offer the expected info, I will ask questions.

I doubt its a hernia - very distinctive mass - no connection to anything.

[Ken_PA]

It sounds as if there might be some bungling there as a way of life, so you have to stay on top of every single thing.

I'd guess that any competent general surgeon is sufficient. But sometimes having a communicative doc is most important. The opposite kind just brushes off questions.

There was a news story years ago of a radiologist in Hong Kong whose business was handling scans sent from America. He'd do something like 100 per hour, which was impossible. Plus, he was often napping anyway. It turned out he was just copy/pasting the same small set of scan reports to everybody. That was an extreme case, but it shows that anything is possible.

Your scan report says the mass is long (4.9cm) and thin. So that could be cancer or a lipoma. A reactive node wouldn't be that shape, they start bean-shaped and get a little rounded when they multiply cells to fight infection.

It also seems to say that it is homogenously all the same inside. There is no mention of normal 'architecture', like this:
http://training.seer.cancer.gov/anatomy/lymphatic/components/nodes.html

There is no mention of the presence or absence of the fatty hilum, which is very important to note for a node.

It might even be a hernia.

I would try to get the radiologist on the phone on Monday. I bet that would be futile, but I'd try.

[cerisecyan]

Thank you.

I just realized that I might be using the wrong term for the location. Extreme upper inner thigh. Funny, the scan header actually reads "scrotum and contents" which is not correct, ha.

We just got the disk with the images today because the surgical office told me we'd need to bring it. I don't know why they didn't give it to us originally.

His appointment with the general surgeon is Feb. 5. I am trying to figure out if I should put more effort into finding a specific surgeon or the one he was referred to is good enough. The receptionist told me that he would be referred to a specialist as the next step if the surgeon deemed it necessary.

Regarding removal, his PCP recommended it and my husband now wants to get it removed regardless of what it is even though I mentioned some possible risks that I had come across earlier. He says that it had started to cause some discomfort. Pretty much he was ignoring it bc he did not want to deal with anything medical.

[Ken_PA]

Thanks for the update. I'd suggest making sure the surgeon has the actual scan disk, or take that with you for the visit (not just the report).

Also, I remember that inguinal resections carry special risk concerning damage to surrounding structures - so ask very carefully about risk versus benefit.

All surgeries have risk anyway. If it is a lipoma, you can always wait.

Let me know how it turns out.

Also please ask the surgeon why the sono could not tell if it's a node or not and let me know. Good luck.

[cerisecyan]

Just to update, my husband's primary care physician has given him a referral for a consultation with a general surgeon. The PCP basically said it should be removed in case it gives him problems later, could be a lymph node, and it's good that it is well defined and localized.
Not really sure what to expect next.

[Ken_PA]

"I guess I mistakenly thought that a noninvasive method would be able to determine that."

I agree with you, I have never seen such an ambiguous report before.


I don't know if this might help you:
http://www.droid.cuhk.edu.hk/specials/lymph_nodes/lymph_nodes.htm

[cerisecyan]

Thanks for replying. I am certainly hoping it is just a lipoma. I guess I mistakenly thought that a noninvasive method would be able to determine that.

So far, no one has really thrown out any terminology/diagnosis other than what I typed in original message. The back lumps were probably lipomas.

[Ken_PA]

Hi, did anyone mention lipoma?

"lumps in his back"
"Hypoechoic nodule measuring 2.4x1.4x4.9cm"

That seems to fit. I don't know that I'd rush into a biopsy in that area. Maybe get a 2nd opinion reading the sono...