extensive medistinal adenopathy without symtoms(symptoms)?

I had a funky cat scan and I am awaiting a surgery appt for biopsy.  The dr. said it is probably either sarcoidosis, fungal or lymphoma, in that order.  He said it is unlikely to be mestatic ca, broncogenic ca because it doesn't look like it on cat plus I have zero symptoms. I can't remember if he said that with my "juicy" medialstinal lymph nodes I would already have symptoms of the lymphoma or not.  I have bilateral hilar involvement, pericarial and one other lymph node enlarged between 1 cm-2 cm.  Rt hilar is 2 cm.

Can you have extensive mediastinal lymph node enlargement, including hilar and pericarinal and not have any other symptoms, such as fatigue, itchy skin and other generalized swollen glands?

[PaulMD]

Hi there.

The absence of symptoms such as fatigue or fever in a lymphadenopathy that is as extensive as this does not necessarily rule out a lymphoma.  There are what we call 'indolent' lymphomas which are very slow growing and indeed produce minimal symptoms.  

Sarcoidosis can also have absent symptoms, and a significant portion of patients are diagnosed accidentally through routine chest x rays.  The slow growing characteristics of the lymph nodes in sarcoidosis can also account for the absence of symptoms.

I believe that a biopsy is really necessary to ascertain the exact nature of these lymph nodes.  It is best that you have this done as soon as feasible.

Regards and God bless.