Enlarged node in Groin

[needadvice1911]

Dear Doctor.  I hope this message finds you well.  In July of this year i presented with Epididymitis.  No bacterial cause was found.  The epidymis was enflamed (ultrasound) and I felt the pain.  There was an enlarged node in my groin at the same time.  Ultrasound report summary on the enlarged node was as follows, "mildly enlarged right goin lymph node corresponding to the area of tenderness with mostly benign features likely reactive and of questionable significance."  it measure 19.3mm x 11.1mm x 5.7mm.  My doctor got the report said there is nothing to worry about.  This was July 31, 2013.  In september the testicle pain was gone but lump in the groin remained.  it was causing pain in my hip, thigh, groin and right flank.  I saw the doc again who said i was giving myself anxiety and that was causing the pain.  the node will eventually go away.  Again, in october I kept feeling the discomfort.  I went to another doctor and we discussed my concerns.  Now they have shifted to lymphoma.  My doc and this new guy i saw both laughed it off.  second doc also thought anxiety was getting the best of me and a node of that size does not lead to lymphoma with no other symptoms.  However, he did a full blood work up and urine.  Also ordered a full abdominal ultrasound as well as specific ultrasound on the groin(right side).  The node is still there but no different.  I don't have the actual summary of the second scan.  I get the write up next wednesday.  Again, my doc is not worried.  What can be causing my node to remain enlarged for this long as the discomfort in my thigh, hip, flank, and groin is not pleasant and I can't do anything to get rid of it.

[needadvice1911]

I'm on the same page as yourself when it comes to letting the body heal on its own.  My largest scare was/is malignancy.  My doctors are pretty confident in ruling that out.  They are the experts.  I would gladly live with some discomfort over having some sort of malignant issues.  If it was go get worse, i would consider surgery.  The pain now is manageable.  Its not the pain that bothers me.  it's more the fact that they can't tell me what is wrong.  I'm glad they don't think its cancer, but still leaves me with questions.  my question is more the interpretation of the report at this time.  Would you agree with that the results of the ultrasound do not identify a reason to worry about malignancy?

[John Irlam, DO, FASCP]

Hey Needadvice,
I think that no news is good news at this point (although I know that doesn't help with your physical discomfort).  I'm a believer in allowing the body to heal itself, especially if the node is decreasing in size.  Surgery isn't without risk and in rare cases can actually make things worse due to possible scarring, infection, etc., but that's just my own personal belief.  I would imagine that nodes pressing on a nerve could definitely cause pain and discomfort.  I'm going to have to defer to you, you know your body better than anyone else as far as if you're improving.  Any thoughts?
John  

[needadvice1911]

Dr. Irlam, I just came back from the doctor.  I swear he read your comment before I saw him because he almost repeated it to me.  He walked me through my blood work, explained the levels and all mine were normal.  Second we went over sonogram results from October 17.  Liver, Billary Tree, gallbladder, spleen, kidneys, pancreas, aorta, IVC, all normal.  Groin sonogram results as follows:
Rest:  No peritoneal Contents.
Valsalva:  No change in the appearance of soft tissue.
Additional Comments:  well defined hypo and hyperecholic masses anterior to the neurovascular bundle with thin cortical mantles as follows:  Right - 16.3mm x 11.7mm x 3.3mm and 11.1mm x 11.0mm x 4.0mm.  Left - 10.3mm x 8.8mm x 4.0mm.
Interpretation - 1) Normal Studies.  2) Normal appearing bilateral groin lymph nodes likely of no clinical significance.  3)no sonographic evidence of  a groin hernia.

So, those are the results.  My doctor says that because the enlarged node on the right is next to a bunch of nerves and presses against them causing my pain/discomfort up and down my right side.  The second node on the right was measured against a node on the left to say they are similar in size and normal.  I asked him if I had lymphoma and he said based on these results he would have to say no.  He also mentioned that the node is a bit smaller now than it was in july.  He suggests to give it time to go down.  if it does not in a few months, he would not oppose removing it to relieve pressure on the nerves.  What are your thoughts?  Does this seem accurate to you?

[John Irlam, DO, FASCP]

Hi Needadvice,
There are a lot of reasons that people have enlarged lymph nodes, including infections or other causes of inflammation (the list goes on forever).  Some people just have large lymph nodes for no good reason. You're right in that lymphoma can cause an enlarged lymph node(s).  These would tend to stay the same or grow in size over the course of time whereas lymph nodes that are decreasing in size are less worrisome.  I agree that you would likely have other symptoms but that is not an absolute rule.  Maybe a different line of questions may help at your next appointment.  If the node is physically causing pain or discomfort and is relatively superficial I think a lot of surgeons would consider removing it just to provide symptomatic relief.  Maybe just the node being irritated is causing it to remain enlarged?  It would be interesting to know if the test results provide any answers.  Will you keep us all informed?
Thanks,
John