Ultrasound to rule out Lymphoma

[DanteTila]

Hi,

To keep the story short, here is my history:

I am 24, male, 5'8" & 150lbs. I had a pacemaker put in on Oct/08 for bradycardia. Diagnosed with Celiac Disease on November 2009. In February 2010, I had an Ultrasound that showed slight mesenteric lymph node enlargement and a slightly enlarged spleen (13inches). Both were minimal so my doctor said not to worry. Recently I had 2 lymph nodes which feel stuck together appear in my right armpit, took about 1 month for them both to surface. They are quite deep and i need to push in to feel them, but one is about the size of a small marble and the other about a pea. They are not huge, but definately were not there before.

Because of this I went to see my doctor to get it reviewed. During the exam, a few other small nodes were felt in my neck and a couple under my jaw. Due to there being quite a few, my doctor set up an ultrasound of my stomach, armpit and neck. She said that see just wanted to make sure it was lymphoma, but reassured me that it likely wasn't since they were not too large and had some give to them.

On top of these small nodes, my relevant blood work in the past has been up and down. Here are my lowest and highest numbers, followed by my most recent:

Lowest and Highest over last year
-----------------------------------
RBC- Lowest:3.5 Highest:4.5 (normal 4.5 - 7)
WBC- Lowest:4.0 Highest:6.5 (normal 4.0 - 11)
Platelet- Lowest:150 Highest:185 (normal 150-400)
Abs Lymphocyte- Lowest:600 Highest:1000 (normal 1500-4000)
Abs Retic Count- Lowest:13 Highest:15 (normal 25-100)

Most Recent: June 20, 2010
------------------------------
RBC- 4.4
WBC- 4.0
Platelet- 180
Abs Lymphocyte- 800 (a little bit low)
Abs Retic Count- 14 (low)

Both numbers did not disturb my doctor too much and was just left to wait and see.

I'm assuming it is nothing serious and all will be back to normal once I get my ultrasound done. I'm just looking for some reassurance or information regarding my history. Does this sound like it will most likely just be nothing? I'm thinking so, but I felt like asking people with past experience would be the best.

Thanks in advance.

[Londres70]

I would think some sort of biopsy should be done.

If nothing is done, which I can't see happening, then it definitely should BE monitored closely.  

[DanteTila]

Thanks Londres. My only issue is about the size of the lymph nodes, from what I have read, 2.4cm is considered abnormal. Do you not think this should at least have a FNA or does it look ok?

Thanks.

[Londres70]

There is an adenoma of the left lobe of the thyroid; adenomas are benign tumors.  The other findings are ok; nothing significant.    

She will probably rule out Lymphoma.

[DanteTila]

Hi all,

I think I'm in the clear, here are my Ultrasound Results. I can't see my doctor for a few weeks because she is away, but this doesn't sound like I have lymphoma. I know nobody here is going to give me doctor analysis, but please let me know your input as I would like to know if I need to follow up about this. I appreciate your help.

---------------
Clinical History
---------------
Multiple Lymph nodes found in the patients neck/axillae during physical exam. Celiac Disease just diagnosed, test to rule out chance of Lymphoma. Blood test done, no signs of infection or mono found.

----------------------------
Ultrasound of Neck & Thyroid
----------------------------
Multiple lymph nodes are seen in the neck. In the right anterior triangle five lymph nodes are counted and the largest is 1.2cm x 0.6cm. In the left anterior triangle, seven lymph nodes are counted and the largest is 1.8cm x 0.6cm. All of these lymph nodes are showing fatty hilum.

Right thyroid lobe is 5.0cm x 1.4cm x 1.5cm, left lobe is 3.7cm x 1.6cm x 1.0cm and the isthmus is 0.3cm. The left lobe, in the middle portion, shows a 0.8cm x 0.5cm well defined slightly hypoechoic nodule and the echo suggests an adenoma. The parenchyma elsewhere is slightly coarse.

Summary: Multiple lymph nodes in right and left anterior triangles of the neck. Normal sized thyroid gland with slightly coarse echotexture and left lobe adenoma found.

--------------------
Ultrasound of Axillae
--------------------
Scans through the left and right axillae show multiple lymph nodes as well. There are five on the right side and six on the left. These lymph nodes show fatty hilum. The largest lymph node on the left is 2.4cm x 0.8cm and the largest on the right shows 2.5cm x 0.6cm.

Summary: Five lymph nodes found on the right axilla and six found on the left axilla.

-----------------------
Ultrasound of Abdominal
-----------------------
No abnormalities found.

[Londres70]

Hopefully you are correct that everything is ok based on the US tech's body language/behavior.  

Keep me posted.

[DanteTila]

Hi,

I just had the ultrasound done of my neck, jaw, thyroid, axillary and abdomen. It's hard to judge the Sonographer's reactions, but she seemed to crack a lot of jokes and seemed very at ease, so it made it feel less likely that she saw anything. I do know for a fact that she didn't see anything in the abdomen because she slipped up and said it looks great after that part was done.

Then she did my neck and armpit areas, but she didn't answer me when I asked how things looked because I think she realized her previous mistake. She still seemed very upbeat and joking, so I doubt she found much so anything. The only thing I could see was when she did my left armpit because my face was near the screen. She kept freezing the images and puting three dots around these little dark areas which I'm assuming she was measuing. No idea, but I'm assuming these were just arteries or something like that.

Anyways, she made me feel quite confident that nothing was going to be wrong with me based on here attitude during the exam and her stomach comment. I will get my results Friday but I feel confident :-)

Thanks and I'll update Friday.

[Londres70]

All the best to you.

[DanteTila]

My doctors tend to dismiss everything as nothing. Maybe they are right, but I almost died because they said my heart was nothing, until it stopped and they gave me a pacemaker. I do worry too much since that day, so I'm sure it will all end up being nothing.

I have US on Monday and results Friday. I will post good results soon!

Thanks.

[Londres70]

In my opinion, it does NOT sound like it is NOTHING; sounds autoimmune to me.  

Hope for the best, see what the US reveals and go from there.  

Keep us posted.