Okay, so I had some ultrasounds and a CT done on my neck about a year ago. The ultrasound showed some abnormal lymph nodes, with the biggest being about 9mm. The CT showed absolutely nothing so my doctor just dropped the case as palpable benign lymph nodes (I made a post about this a little over a year ago). Well now I can feel more lymph nodes (one on the side of my neck, a few more in the submandibular/sub mental region, and one on the opposite lower side of my neck), all about a centimeter size. The original nodes are still there and don't seem to have grown. I have to get another ultrasound done and most likely a FNA. My new doctor did blood work and doesn't seem too concerned and doesn't think it's cancerous based on that, she is just doing the FNA just in case. From what I've read, Lymphoma usually doesn't make an appearance in blood work, even if I've had it for almost two years.
- I'm a 20 year old female, I first found the the nodes when I was 18.
- it has taken about a year for 3 or 4 more nodes to pop up.
- Indolent lymphomas are extremely rare for someone my age so I don't THINK it could be that.
- Is it normal for Hodgkin's to grow this slowly?
- I have impacted wisdom teeth and swollen gums from when I had braces, so maybe that could be causing this?
Unfortunately, I'm a huge hypochondriac, so these tiny little lumps in my neck are causing me all sorts of problems.
Also to add: The nodes feel hard-ish(?) but are super mobile. And the ultrasound noted some hypervascularity.
"I have impacted wisdom teeth and swollen gums from when I had braces, so maybe that could be causing this?"
Yes, that's most likely. However, that doesn't quite explain why there is that odd cascading behavior - and that behavior probably explains ordering the FNA.
Can you post the sono report? There are some key things to look for, to mostly rule out cancer.
"Unfortunately, I'm a huge hypochondriac..."
My own belief is that people who are prone to worry also likely have very reactive immune systems.
Here is is very first ultrasound report. When they did the follow up there were no significant changes, and then the CT scan showed nothing significant.
I went to the doctor in
February due a swollen lymph node in my neck. I told her that I had first noticed it in January and that it has neither increased or decreased in size from what I could tell. She didn't seem TOO concerned about it, but ordered an ultrasound for me anyways. I went to get an ultrasound the next day and these were the results:
Ovoid left submandibular lymph node (level IB) noted, measuring 10 x 5 x 9 mm (transverse, AP and CC dimension respectively). Internal architecture is heterogeneous with lack of normal hilar morphology. Intralesional hypervascularity noted with a
centralized feeding vessel. Adjacent smaller hypoechoic lymph node noted measuring 7 x 5 x 5 mm. This also demonstrates lack of normal hilar morphology. Visualized regional musculature demonstrates a normal sonographic appearance.
Ovoid hypervascular node at the left submandibular region, suspect inflammatory (reactive) lymph node. However given abnormal architecture and hypervascularity, malignant node or other neoplasm remain considerations. Consider followup ultrasound in 2-3
months for revaluation. "
I had the TB skin test done when I was around 16 or 17 years old for a nursing class at my high school and it was negative. Of course, I could have had it again. I don't think it was tested for in the recent blood work.
Another possibility for nodes that seem permanently enlarged and also hard yet mobile would be some granulomatous disease. Yes, I'd very much think that your 'tonsil stones' as you described last year are related.
From "A clinicopathologic series of 22 cases of tonsillar granulomas":
"a number [of cases] may not develop an identifiable etiology, with the granulomas probably representing an exaggerated immune response to chronic tonsillitis."
You might have something similar to but yet different from Kikuchi disease or Rosai-Dorfman disease. But your nodes don't have necrosis in the center, while they are too small for Rosai-Dorfman. The histiocytes could be in the tonsils and also in the nodes, surrounding and walling off some common infection.
Did you start off in the very beginning with a fever?
As you are learning, you should eventually feel as if your head will explode from too much information. Then you'll know you are proceeding correctly :)
Are you of Japanese descent? Then Kikuchi would be more likely, even though your nodes are not necrotic.
Not Japanese descent. And I don't think I had a fever. I get tons of sinus infections and am constantly treated with antibiotics with no luck with decrease in lymph node size.
Can chronic tonsillitis be fairly asymptomatic?
No, they just diagnose by doing the typical examination.
The nodes that are swollen are the submandibular, sub mental, and superficial cervical on the left and then the posterior cervical on the right. Do those usually swell up with sinus?
I have really bad nasal allergies. And acne. They suspect the nasal allergies to be causing the sinus infections.
Will the FNA at least be able to tell me if there is any sort of malignancy? Is an FNA accurate as far as finding out how serious of a situation I am in? I won't really need specifics, but I'm currently in the process of transferring schools and moving so this is a really inconvenient time to be investigating this (I know, disease is never convenient).
Okay, had a new U/S done. Obviously my nodes have grown and multiplied. The radiologist said since they are so thin, a FNA would be pointless, so I just have another follow up ultrasound in 6 months. I might get a second opinion from an ENT soon.
Bilateral multiple nonspecific neck lymph nodes are visualized some of which measure slightly enlarged right neck greater than the left.
Majority are within normal limits for size.
At the upper neck there is a 2.1 x 0.5 x 2.3 cm mildly enlarged lymph node which does however maintain its normal shape and visualization of central fat
Mid right neck 1.2 x 0.3 x 1 cm mildly enlarged lymph node which does maintain its normal shape and visualization of central fat.
At least 5 lymph nodes are demonstrated only one of which is mildly enlarged measuring 1.9 x 0.5 x 1.7 cm. The remaining 4 lymph nodes less than a centimeter and sonographically unremarkable.
All lymph nodes visualized maintain normal reniform shape and central fat echogenicity.
This is important: if you haven't already been tested for an immunodeficiency disease, then you should be. I was assuming you have had your immunoglobulin levels (antibodies) tested because of your history of frequent infections. If not, you should be and something like CVIDS can account for all of your troubles, including sinus infections, lymphadenopathy and possible granulomas. It's just a blood test.
My doctor called and basically just reiterated my ultrasound report to me. She wants to do a follow up U/S in December or January and see if there are any changes. If there are, I think she may want to do a CT Scan. Ill also ask about the immunoglobulin test, because she didn't test for that last time.
So, I was overlooking my blood work, and a hemoglobin test was conducted. Along with a mono test. Basically all autoimmune diseases I think were covered in my blood tests and they all came back fine. I messaged my doctor and requested to go ahead with the CT scan now. Should I be worried?
I would want the immunoglobulin test.
Did you have a recent CBC?
AFAIK, if your CBC is normal, that would tend away from active infection and tend toward granuloma.
LYMPH NODES: No lymphadenopathy. There are small bilateral cervical chain lymph nodes which are morphologically normal and do not meet size criteria for pathologic enlargement. Largest node on the right is a level 2A node that measures 7 mm short axis (2, 38). Similarly largest node on the left is a 2A node measuring 6 mm short axis (2, 37). No abnormal nodal enhancement. The nasopharyngeal adenoids and tonsillar pillar regions appear unremarkable.
So, what do you think?
Yes, this is a new scan.
Can infections go unnoticed in blood work?