The interventional radiologist that did the FNA said that "it was larger than the rest but that was normal underneath the jaw area".
Submandibular nodes do tend to be larger and rounder than other neck nodes. But if it's larger than the palpably enlarged neck nodes, then probably it is indeed enlarged from it's own resting state - while still in "normal", not-cancer range. (But can you find out the actual dimensions, to be sure? There has to be paperwork on the procedure somewhere.)
11 sticks with the needle is a lot, so that also argues in favor of the node being enlarged.
"It was within a couple inches range of all the others..."
That's how HL spreads (though not necessarily NHL).
"...just much deeper?"
Yes, you probably didn't feel that one because it is deeper - not because it is un-enlarged.
It was very considerate of them to give you a call so soon.
Don't forget to post the biopsy report when that is available.
"Overall though do you agree this should put my mind to rest?"
Yes, it is further evidence of not-cancer.
I would like to see only the dimensions, though. Maybe somebody could read that over the phone to you. To me, 11 times means it was large and she wanted to hit every area of it. To me, 11 times also means she didn't see any unusual spots inside of it - or she would have aimed for those spots.
She didn't see any bad new blood vessels on Doppler, either.
As for the actual path report, which is separate, I'd like to see if they looked for inflammation indicators. I'll say again that I am not a doctor but it sure looks like inflammation and fibrosis to me.
"Even slow growing would have progressed to swelling the nodes further wouldn’t it have?"
Yes, most probably.
In addition, if each node enlarged very quickly, like overnight, then suddenly stopped growing? That would be very, very hard to associate with how cancer behaves. (Fast, then stop.) But that's exactly how a reactive node, followed by scarring, could behave.
Btw, did we rule out teeth/gum problems as the origination?
"Unless a cavity/sensitive tooth could cause it?"
Yes, that can. There can also be an occult infection in/around the root, which can send biochemical signals down the lymphatic drainage in the neck.
"I also should mention I can feel several nodes in my crotch region..."
Whoa! Do the doctors know that? Was there an ultrasound? Post that. This is "generalized lymphadenopathy" (2 regions), which is a higher level of concern.
"normal for the area..."
They are naturally larger when enlarged; but being palpable means something is going on there.
I still think it's not-cancer, but the odds of getting an excisional biopsy are now increased - to find the actual cause.
"they are symmetrical so I’m guessing those are completely healthy nodes"
Not really; generally oval is good, round is not good. But round is not automatically cancer.
"Ultrasound morphology of inguinal lymph nodes may not herald an associated pathology"
"can muscle strain cause enlargement?"
Not really, but trauma certainly can - including 'crush trauma'.
Pain chemicals likely can, especially with a hyper reactive immune system.
Where is the latest report from the neck ultrasound?
Do you flush-red/blush a lot? Have anything like asthma?
"The doc has actually felt the groun region and said they didn’t feel enlarged or out of the norm."
Okay, then we can discard the notion of generalized lymphadenopathy. I wouldn't ask for the sono, even more so because "they are symmetrical in that on each side of the groin they are present in the same places and at the same sizes"
The doc would rightly feel that asking for a sono there is unreasonable.
"I figured I’d wait for the three month follow up ultrasound and hematology appointment but what do you think here?"
The biopsy might reveal the real cause of the node problem. Or, it might say that "there is an inflammatory process of unknown etiology".
The biopsy can't 100% rule out cancer anyway because the mind can then always shift to thinking that it's the "other" nodes that should have been excised and tested.
Overall, I'd choose to wait, as you are planning to do.
As for low WBC, have you looked into hypoalbuminemia?
"it can actually be a sign of very good health"
Yep. As long as there is no identifiable pathology causing it, it can be seen as a sign of low systemic inflammation.
The shape of your node is very good, as you know.
Yes, ANA is a fuzzy thing. A normal, healthy person can indeed have elevated ANA - then there is the pattern, such as speckled, etc.
If you wanted to evaluate any possible downside, it might be contained in something like this:
"Risk factors for ANA positivity in healthy persons"
But I wouldn't be concerned at this point, and regard the ANA as just another sign of unusual, lifetime baseline immunity.
I would do the biopsy only if the pathologist would also be instructed to look for all inflammatory cells, and granulomas. Maybe even special stain for mast cells. Do you think you might have a lot of anxiety under local? Maybe ask for twilight anesthesia - and I'd alert any anesthesiologist that "I have a very reactive immune system", so they are on guard.
After the biopsy, definitely ask any medico who visits you, "How did it look (grossly)?" and wait for them to say "normal". Good luck and let me know how it goes.
"...so I would assume that still stands as me being in the clear?"
Yes, I would guess that is probably true.
"My anxiety stems more from being put under than the procedure itself. I like being in control, awake I would be and I’d hold still, anesthesia is very much not in control if that makes sense."
Okay, that is perfectly understandable.
"Also the hematologist said that one thing that was very reassuring was the fact they weren’t growing."
Yes, I've also said that to you more than once. That comes under the heading of 'behavior'. That's especially true if the node grew overnight, or nearly that fast - then it would be extremely rare and almost miraculous for it to then stop growing. But growing overnight and plateauing is typical behavior of a reactive node. That's why I ask almost everybody if it grew overnight.
"...it would most definitely have at least doubled in size in a year he said... Does that line up with what you’ve heard as well?"
Double? No, not true at all from what I have heard but also seen. Did you possibly misunderstand the hema?
"Thanks for your help by the way!"
You're welcome :)
"Do you agree that there would be at least a definite noticeable change in lymph node sixes after a year even in slow growing?"
Very probably. Almost certainly. But still, these types of questions are a matter of probabilities. IMO, the most improbable scenario is that a cancer grows fast at the beginning, then turns to not-growing at all.
Theoretically, a cancer can do almost anything, and so can the immune system. A cancer is thought of as a mutation in a gene, but in a practical sense it's really an accumulation of mutations - and each new mutation can change behavior which usually makes the cancer worse.
The immune system can be not-killing, then suddenly (and very rarely) become able to detect and kill a cancer - maybe sometimes just because you got a cold and that changed your immune cells. (Anti-cancer vaccines are meant to work the same way.)
Even with a full excisional biopsy, there are rare times when it's not known what type of cancer is present, or if there really is a cancer. More uncertainty.
I've always aimed to give you the most truthful answers, and not merely the most positive answers (which could be less accurate). So when I say that I don't think you have a cancer, I'm not just being reassuring for it's own sake. That said, I'll also state that benign inflammation predisposes somewhat to developing a cancer, mainly because of the increased cell division as immune cells proliferate. That's another reason for a biopsy to look for whatever inflammatory cells are present.
A side note: CT is more accurate on sizing than US. But that's not so relevamt for your case, I just mention it to be thorough.
'Also my ANA being 1:70 I asked the NP who ran it and she said the “verifying test came back negative” what does that mean?'
Probably that, since sometimes a test can just go bad for various reasons, a second test is done to see if it agrees with the first one.
"Is it true that most people with ANA are fine?"
Probably, yes. And there's even this: "[antinuclear antibodies] Moreover, the deficiency of vitamin D in the body of patients correlates with occurrence of these antibodies."
You could websearch--> positive predictive value ANA
to get more and more complexity.
"It just seems like such a fluke deal but with my family history."
Yep. So never compare yourself to averages -- unless they are the averages of people with unusual immune systems. Usually :)
Generally, the US is more of a fuzzy image:
But a CT is sharp. US is also more prone to operator variability. Even so, the series of USs *would* detect gradual enlargement.
I think shape is more important than size, because a small round node might be cancer. (but submandibulars are more rounded naturally).
"At this point that seems to be the biggest factor."
I don't recall, did you ever say if the hilum is present?
"even minor dental issues can cause nodes to ever so slightly enlarge..."
I don't see why it couldn't even be significant enlargement, if a tooth is pumping pro-inflammatory biochemicals downstream to nodes. There would also be immune cells by a tooth, that make shredded pieces of bacteria they'd encountered, then go downstream to nodes with that -- so as to tell other immune cells: proliferate and kill these things.
I'm fairly sure I'd mentioned 'dental' to you about a month or two ago, as a possibility.
"My dentist claimed only a serious infection can do that"
In normals? What about in highly reactive people? (Can eating one peanut or sesame seed kill a person?)
"And with my ANA you wouldn’t have concerns even with the family history?"
To the contrary, with your Hx and Fx I'd rather expect elevated ANA. But not really high ANA.
"...if the verifying test came back negative and that was the same test I guess that means I may not even have it?"
Yep. Unless the 2nd test was a false negative. Or your internal state might change over time, so each test was correct at it's own moment in time.
"Sorry if I seem confused I kind of am."
Good :) That is the natural result of delving into this thoroughly, instead of just shrugging it off - as most people would. It's a lot to absorb and you are doing very well at it.
"Everything I’ve read about that test seems to go every direction."
Yep. Just think of the ANA as suggestive, not definitive.
"But I only had one blood draw for this test, so is it possible for them to perform a verifying test on the same sample?"
Some substances being tested for in blood or urine samples quickly degrade. Degradation might be prevented/delayed by refrigeration. For biopsy samples, preservatives or freezing can be used. When antibodies themselves are used as a treatment, they arrive freeze dried. Other than all that, I don't know.
Without seeing the report, I'd think that the 1.7 is the concentration (e.g. ug/ml) of a specific antibody subtype.
The ratio notation (e.g. 1:1000 is a thousand to one) is the dilution of the sample.
They are always diluted. AFAIK, they dilute until the glowing Ab's are no longer detected. Then they might next measure the concentration of selected subtypes of AN antibodies. (ANA is a collection of various Ab's.) That's the classic way, there might be newer ways.
Very roughly, it goes like this:
- antibodies bind to antigens
- they line a dish with cells that have lots of suitable antigens
- they dilute and then add your blood to the dish
- any ANAs in your blood bind to the antigens in the cells
- they rinse the dish, the bound AB's remain
- they add a molecule that glows under fluorescent light to the tail ends of the bound Ab's
- they shine a fluorescent light and observe the microscopic pattern of the glowing dots