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Maternal (Expert Forum)
Re: Unusual enlarged lymph nodes
Patient medical question and answer from The Maternal and Child Health Forum. Health topic area and articles about newborn care
Re: Unusual enlarged lymph nodes
by HFHS.M.D.L.M., Jan 01, 1995 12:00AM
Posted By HFHS.M.D.L.M. on February 12, 1999 at 00:10:50:
In Reply to: Unusual enlarged lymph nodes posted by Kim on February 09, 1999 at 20:35:24:
In late October 98 my 13 year old son came down with a slight fever and was generally unwell. I was letting the illness run its course until after about 5 days he complained of a sore lump on the side of his face. I though it must be an infected saliva gland or something. It turned out it was a lymph node. It was on the side of his cheek down close to his jaw line 1/2 way between his jaw and his chin. The glands in his neck were also swollen he was feeling quite unwell no appetite, very tired. My GP suspected mono she said it presented as a classic case. The blood work showed elevated mono sites the level was 9, but it was negative for mono. She said that he had a mono-like illness. The school provided my son with a tutor. He sleep constantly and ate almost nothing he lost 10 pounds. He went back to school after the Christmas break. He gained the weight back. He seemed a lot better energy was never returned to normal. He was always late for school as he was almost impossible to get up sometimes it would take over an hour of steady harrassing to get him up. Last week on Feb 4 he called home form school wanting to come home as he didn't feel well he felt sick and had a headache. He came home and said he didn't feel as bad as when he was first sick but he was starting to feel that way again. I took him to my GP today. She was very concerned about the fact that his lymph nodes were still so enlarged. I told her that the ones on his neck had never gone down very much but that the one on his cheek went down but never went away. It is now big again. She said she thought it was harder this time. She is doing blood work and refering him to an ENT specailist. She feels they would probably want to biopsy it. She didn't explain why as my son was there but I know it is to rule out lymphoma. Our health care as good as it is runs at a snails pace. I don't even have an appointmnet yet and with most specialist it can take from a month to a year to get in. I would hope in my son's case it won't be longer than a month. But in the mean time my husband and I are quite stressed at the possibilities. My son has always seem to has big glands on his neck not as big as they are now but always there about the size of a grape normally now they are twice the size of a grape and the one on his cheek is a little bigger than a marble. They are only painful if you manipulate them too forcefully. I know this is a long letter. I would really appreciate some imput we are very concerned. Thank you for your time. Kim
Dear Kim ;
Lymph node enlargement ( lymph nodes > 1 cm in size ) is a common presentation for many disorders in children , infectious etiologies being the most common , malignancies being lower on the list of causes.
Lymph nodes can enlarge for many reasons :
1. when fulfilling their normal function as part of the immune system, their cells proliferate through an immunological response . This is especially active in children and can explain the frequent observation of lymph node enlargement in pediatric infections and other chronic inflammatory disorders such as juvenile rheumatoid arthritis.
2. bacteria or their products , when entering the lymph node , can stimulate an inflammatory response and cause enlargement with tenderness and redness.
3. malignant cells can arise in the nodes themselves , or may arrive from distant sites and infiltrate the lymphnodes , causing them to enlarge in size
4. rare storage diseases can infiltrate the lymph nodes and produce local or more commonly , generalized lymph node enlargement.
From infections , the most common causes would be viral infections , if the lymph node enlargement is localized to the neck ( cervical lymphadenopathy ) , viral upper respiratory infections are the most common cause .
Infectious mononucleosis is well known for being a cause for cervical lymphadenopathy. It commonly presents with a low-high grade fever , cervical lymph node enlargement , increased fatigue , loss of appetite and other symptoms and physical findings depending on its variable effect on different organ systems. Other "infectious mono-like" infections may produce a very similar picture , these include cytomegalovirus, toxoplasmosis , adenovirus , viral hepatitis , HIV , rubella ( German measles ) and strept throat . Not to make you more concerned , the more serious infections ( HIV , hepatitis , toxoplasmosis ) mentioned above would have other manifestations that you have not mentioned in your letter.
The monospot test that was done for your son may have been negative in the early stages of mononucleosis infection . Specific EBV ( Epstein Barr Virus , the cause of mono ) antibody titers can confirm the infection if you still suspect it being the cause . Nevertheless , mono tends to be a self limiting disease in most cases with gradual recovery . Fatigue , malaise may wax and wane for weeks to months . A specific link between chronic fatigue syndrome and EBV has not been found .
Lymphoma , tumor of the lymph nodes , can present in childhood ( in two forms , Hodgkins and Non-Hodgkins , both with similar presentations ). Enlarged lymph nodes maybe isolated to a regional area or have a generalized distribution with or without systemic symptoms such as fever , malaise , night sweats , weight loss and loss of appetite . its very unusual for a true lymphoma patient to gain the weight loss as this is a progressive disease .Malignant nodes tend to be rubbery and nontender , occasionally matted . These lymph nodes dont usually wax and wane in size ( in the more common childhood form of Hodgkins lymphoma ) but gradually increase in size with time .
Other malignancies that can cause lymph node enlargement include local tumors( the LNs tend to be hard in consistency in most cases ) or generalized like leukemia ( with abnormal leukemia cells seen on the blood count/ blood picture).
With the confirmation of cervical lymphadenopathy with systemic manifestations , or unusual symptoms , such as generalized itching , hemolytic anemia , and chest pain after alcohol ingestion ( just to complete the features ), an immediate work-up for malignancy is warranted . When these symptoms are not present and the cervical lymph node enlargement continues over 3 weeks , and no other specific cause is found , a lymph node biopsy is warranted . Most lymph node biopsy results yield a "benign inflammatory hyperplasia" , very few of them turn out to be true malignancies.
For Most illnesses to be diagnosed correctly , a complete history and physical examination is necessary , with the aid of a few investigations . A full discussion of your concerns with your physician , together with her clinical findings may help define the best care plan for your son.
Thank you for your question
Disclaimer : this information is provided for educational purposes only. Your physician is ultimately responsible for your health care , diagnosis and treatment .
keywords : cervical lymphadenopathy*,( Pediatric hematology )
In Reply to: Unusual enlarged lymph nodes posted by Kim on February 09, 1999 at 20:35:24:
In late October 98 my 13 year old son came down with a slight fever and was generally unwell. I was letting the illness run its course until after about 5 days he complained of a sore lump on the side of his face. I though it must be an infected saliva gland or something. It turned out it was a lymph node. It was on the side of his cheek down close to his jaw line 1/2 way between his jaw and his chin. The glands in his neck were also swollen he was feeling quite unwell no appetite, very tired. My GP suspected mono she said it presented as a classic case. The blood work showed elevated mono sites the level was 9, but it was negative for mono. She said that he had a mono-like illness. The school provided my son with a tutor. He sleep constantly and ate almost nothing he lost 10 pounds. He went back to school after the Christmas break. He gained the weight back. He seemed a lot better energy was never returned to normal. He was always late for school as he was almost impossible to get up sometimes it would take over an hour of steady harrassing to get him up. Last week on Feb 4 he called home form school wanting to come home as he didn't feel well he felt sick and had a headache. He came home and said he didn't feel as bad as when he was first sick but he was starting to feel that way again. I took him to my GP today. She was very concerned about the fact that his lymph nodes were still so enlarged. I told her that the ones on his neck had never gone down very much but that the one on his cheek went down but never went away. It is now big again. She said she thought it was harder this time. She is doing blood work and refering him to an ENT specailist. She feels they would probably want to biopsy it. She didn't explain why as my son was there but I know it is to rule out lymphoma. Our health care as good as it is runs at a snails pace. I don't even have an appointmnet yet and with most specialist it can take from a month to a year to get in. I would hope in my son's case it won't be longer than a month. But in the mean time my husband and I are quite stressed at the possibilities. My son has always seem to has big glands on his neck not as big as they are now but always there about the size of a grape normally now they are twice the size of a grape and the one on his cheek is a little bigger than a marble. They are only painful if you manipulate them too forcefully. I know this is a long letter. I would really appreciate some imput we are very concerned. Thank you for your time. Kim
Dear Kim ;
Lymph node enlargement ( lymph nodes > 1 cm in size ) is a common presentation for many disorders in children , infectious etiologies being the most common , malignancies being lower on the list of causes.
Lymph nodes can enlarge for many reasons :
1. when fulfilling their normal function as part of the immune system, their cells proliferate through an immunological response . This is especially active in children and can explain the frequent observation of lymph node enlargement in pediatric infections and other chronic inflammatory disorders such as juvenile rheumatoid arthritis.
2. bacteria or their products , when entering the lymph node , can stimulate an inflammatory response and cause enlargement with tenderness and redness.
3. malignant cells can arise in the nodes themselves , or may arrive from distant sites and infiltrate the lymphnodes , causing them to enlarge in size
4. rare storage diseases can infiltrate the lymph nodes and produce local or more commonly , generalized lymph node enlargement.
From infections , the most common causes would be viral infections , if the lymph node enlargement is localized to the neck ( cervical lymphadenopathy ) , viral upper respiratory infections are the most common cause .
Infectious mononucleosis is well known for being a cause for cervical lymphadenopathy. It commonly presents with a low-high grade fever , cervical lymph node enlargement , increased fatigue , loss of appetite and other symptoms and physical findings depending on its variable effect on different organ systems. Other "infectious mono-like" infections may produce a very similar picture , these include cytomegalovirus, toxoplasmosis , adenovirus , viral hepatitis , HIV , rubella ( German measles ) and strept throat . Not to make you more concerned , the more serious infections ( HIV , hepatitis , toxoplasmosis ) mentioned above would have other manifestations that you have not mentioned in your letter.
The monospot test that was done for your son may have been negative in the early stages of mononucleosis infection . Specific EBV ( Epstein Barr Virus , the cause of mono ) antibody titers can confirm the infection if you still suspect it being the cause . Nevertheless , mono tends to be a self limiting disease in most cases with gradual recovery . Fatigue , malaise may wax and wane for weeks to months . A specific link between chronic fatigue syndrome and EBV has not been found .
Lymphoma , tumor of the lymph nodes , can present in childhood ( in two forms , Hodgkins and Non-Hodgkins , both with similar presentations ). Enlarged lymph nodes maybe isolated to a regional area or have a generalized distribution with or without systemic symptoms such as fever , malaise , night sweats , weight loss and loss of appetite . its very unusual for a true lymphoma patient to gain the weight loss as this is a progressive disease .Malignant nodes tend to be rubbery and nontender , occasionally matted . These lymph nodes dont usually wax and wane in size ( in the more common childhood form of Hodgkins lymphoma ) but gradually increase in size with time .
Other malignancies that can cause lymph node enlargement include local tumors( the LNs tend to be hard in consistency in most cases ) or generalized like leukemia ( with abnormal leukemia cells seen on the blood count/ blood picture).
With the confirmation of cervical lymphadenopathy with systemic manifestations , or unusual symptoms , such as generalized itching , hemolytic anemia , and chest pain after alcohol ingestion ( just to complete the features ), an immediate work-up for malignancy is warranted . When these symptoms are not present and the cervical lymph node enlargement continues over 3 weeks , and no other specific cause is found , a lymph node biopsy is warranted . Most lymph node biopsy results yield a "benign inflammatory hyperplasia" , very few of them turn out to be true malignancies.
For Most illnesses to be diagnosed correctly , a complete history and physical examination is necessary , with the aid of a few investigations . A full discussion of your concerns with your physician , together with her clinical findings may help define the best care plan for your son.
Thank you for your question
Disclaimer : this information is provided for educational purposes only. Your physician is ultimately responsible for your health care , diagnosis and treatment .
keywords : cervical lymphadenopathy*,( Pediatric hematology )
