Are we going toward the right medical direction?

[Vbyers6]

Hello, here is some background info: 53yo male..healthy....only symptom is constant dry cough.  ct scan does show swollen lymph nodes in mediastinal and one swollen lymph node between the stomach and spleen.  Blood work is completely normal. Erthyrocytes and WBC count are normal. But blood work does show past exposure to EBV,CMV, and range of Toxoplasma IgG Ab is high, had TB active in 1985 and treated for it for 6 months. We just completed the PET scan and Dr. states lymph nodes in chest do "light up", does the term light up mean definitely malignant?

Also, our next visit will be for a chest biopsy with the thoracic surgeon, can anyone explain me the procedure? How long is the surgery? is it open chest? Scarring? Time spent in hospital?

His LDH level is normal and the Dr. did state that if it is Lymphoma that she would be surprised because elevated LDH and lymphoma come hand in hand.  Any ideas of what disease this can be?  

Any feedback or support would be appreciated, I just can't sleep and need some sort of direction to look in.

Thanks Again!

[Fernando Roque, MD]

Hi.  I think that your doctors are going in the right direction by choosing to have a biopsy of those mediastinal nodes done.  Because of your previous history of infection, there is a possibility that those enlarged nodes represent a lingering infection.  But the possibility of malignancy cannot be ruled out at this point, so the biopsy really needs to be done to settle the issue of diagnosis.  The fact that the lymph nodes "lighted up" on PET scan does not prove that they are malignant.  It just means that there is increased metabolic activity in those nodes, which may suggest the cancer, but this may also be seen if an active infection is present.

There are different ways of doing a chest biopsy, and I don't know which one the thoracic surgeon will do. He may opt for a CT scan guided fine needle aspiration biopsy. This involves inserting a long needle through the chest wall and into the mass to gather tissue samples. Another option is to make a small incision in the chest wall, just wide enough to insert a laparoscope (a long tube which is used to visualize the inside of the chest as well as take samples of the nodes).  The third option is to perform an open biopsy - a larger incision on the chest wall (thoracotomy) is done and the mediastinal nodes excised once the chest wall has been opened.