Lump on neck

[Tina6474]

My 17 yr old daughter felt a lump on side of neck. Doctor measured it at 1.4cm and ordered an ultrasound. It is hard and rubbery and does not hurt. Ultrasound results state it has grown to 2.6cm x 1.3cm (in 1 month) and has no fatty hilum. Performed at a level 5 in the area of palpable abnormality. Mild increase in vascularity.
good
Has anyone else had a similar case and what was it?

Thank you, in advance, for any replies.

Worried Mom

[Ken_PA]

Hypoechoic (the sound waves are not being returned very much) can mean that either:

-the 'internal architecture' of the node is destroyed by cancer
or
- it is filled with fluid as from inflammation

but the latter seems less likely because the node is so large. However, children tend to get overly large nodes, but I don't know if that still applies to a 17 year old or if her size is way too large regardless.

Cat scratch fever can produce swollen nodes in the neck, but probably not that large and they are usually painful.

One thing that tends to say not-cancer is that it is still oval, not round.


The most alarming finding is that the hilum is gone. Along with being so large and growing rapidly, it sure looks like a biopsy is necessary.

I'll be very interested to hear what develops each step of the way.

[Tina6474]

Thank you for responding. I was shocked at her lack of knowledge about the hilum when it took me 2 seconds to look it up.  Regarding the vascularity, it doesn't say anything else other than what I wrote. I will call the ENT on Monday to see about getting in sooner.

As far as TB, she hasn't been sick at all since early this year with a common cold. She doesn't have a cough, fever, runny nose, nothing!

I am in Southern California in United States.

The only other word I realized I left out was that it was a hypoechoic stucture that measured 2.6 x 1.3cm.

Thank you for your help in educating myself with all of this.

Tina

[Ken_PA]

I mean calling the ENT on Monday. You wouldn't get anyone today, I'd think.

[Ken_PA]

I'd think that she needs to see an oncologist or hematologist immediately. The pediatrician apparently can't be trusted about this.

"she said she didn't know what the hilum was when I asked her". It's very worrying that she is charge of the decisions.

Can you call the ENT's office and read to them over the phone about:

1) lack of hilum
2) large size
3) rapid growth
and also
4) "Mild increase in vascularity" though the significance of that might depend on where inside the node the vascularity is seen (peripheral is bad).

The ENT might hopefully say to bring her in quickly and not wait for the scheduled appt.

I suppose it might also be tuberculosis. Is she coughing? Waiting for this to go away on its own seems unbelievable to me.

Which country are you in? Have you quoted the sono report in its entirety? No other words in it?

[Tina6474]

Thank you for your response. I FINALLY got her pediatrician to refer us to a specialist. She is referring us to an ENT. When I spoke with her yesterday on the phone, she said she didn't know what the hilum was when I asked her. She seemed to think that teens get infections and it will go away. I pushed and got the referral, so I will update after that visit but I am going to request biopsy. Seems abnormal to me.
Prayers for my girl!

[Ken_PA]

Hi, sorry to say but that does sound very troubling.

The loss of the fatty hilum almost always occurs when cancer cells are multiplying and replacing normal cells in the lymph node. It is still remotely possible that a really raging inflammation can do the same, but unlikely.

When cancer cells multiply a lot, they need more blood supply to feed themselves. So they stimulate production of new blood vessels, i.e. "vascularity".

At 2.6cm, that is likely too large to be anything except cancer. But ironically, the fast rate of growth usually means a cancer that gets killed more easily by anti-cancer treatments. The slower growing kinds are usually harder to kill off.

So she needs ASAP an excisional biopsy so that pathology can be done to identify exactly what the cells inside are. The docs must have scheduled a biopsy already right?

At her age, Hodgkin's Lymphoma is more likely that Non Hodgkin's Lymphoma -- which is preferable because Hodgkin's Lymphoma is generally more treatable and treatment can be very successful. That's what you should focus on at this point.

Everything is a matter of probabilities until the biopsy is done. I'd ask the surgeon immediately after the biopsy about what the removed node and surrounding area looks like. That can tell a lot.

At some point, they'd also probably want to do a scan (such as a PET)  to see if there are any more nodes elsewhere, besides the usual locations of axillary and inguinal.

When is her biopsy scheduled for?