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In depth ultrasound results 13 months after lymph node enlargement.

Hello again, I just had a follow up ultrasound regarding my lymph nodes and again, from the previous one three months ago it notes ‘slightly less prominent than the previous neck exam’ on the left nodes. Now this time I asked a lot more questions however. The largest node in my upset neck almost under my chin is 1.4 centimeters long and .4mm in diameter. The PA said these nodes over 1 centimeter are common and actually very normal I guess I always thought anything over a centimeter was concerning but she said that is if it’s over a centimeter in diameter. Is this true? Looking back on the articles I read I am seeing diameter mentioned much more than length in terms of concerning etc. obviously them being a tiny bit smaller is a good sign as well everything considered. She said the morphology looked well and I seen the nurse tech using Doppler on the exam screen as well.

So basically is being basicall 1.4 centimeters ‘tall’ as she put it, concerning or can nodes under the jaw normally be that large? (I know they say nodes near the jaw tend to be larger)

That and she said I had a few measure just over a centimeter in length but the 1.4 being the largest. She did mention one of those nodes was one of the ones biopsied.

In the end obviously they must have been that size this whole last year at least I’m assuming since growth has never been mentioned and many actually appear smaller.  

Other than that every node was .7-.1 she says.
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1081992 tn?1389903637
COMMUNITY LEADER
"So I guess I’m wondering is 1cm in the long axis something that can be ‘original from birth’ so to speak?"

"Still I’m just curious if having a handful of 1.2-1.4 cm lymph nodes is something worrisome or just natural anatomy..."
Fibrosis, maybe granulomas... maybe also some reactive proliferation.

I don't think that a node that is just sitting and waiting for some stimulus would be 1.4cm  in length. It would be smaller. You have several hundred nodes, some hundreds are in the neck -- most are not big enough to be seen on a US.

On https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5073388/
it says: "Lymph nodes ranged from 0.4 cm to 2.7 cm in diameter... The largest lymph node analyzed was an extraglandular parotid lymph node, which measured 2.7 cm."
But I don't see any 2.7 in the actual table. If there is a real 2.7,  maybe it's a genetic fluke or else some reaction.


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7 Comments
So I guess then my question goes back to my previous question at the heart of all this, why are they not doing more tests? The radiology reports “non-reactive, non pathological lymph nodes” the largest being 1.4 cm in long axis and .4cm in the short axis”

That implies they don’t believe it’s reactive, if it’s not reactive, and it’s been there so long and is still so large why is there no concern? Why isn’t there more precedence for a slow growing lymphoma? I have a handful over a centimeter they said however the ENT kept saying that they were ‘normal young person lymph nodes’ to me it seems much more concerning especially given the family history with Hodgkins.
That article listed other nodes in random people as well not quite 2cm’s but several over 1, sometimes even diameter. So I’m just having a hard time believing an infection would scar 20+ nodes. I can feel 8-10 enlarged since my chest infection, that’s excluding the confined plus ones they found deeper (unless those truly are normal sized) but everyone who seems to have scar nodes says they have 1-2 not this many. I’m just honestly really frustrated of the whole situation. Why are the doctors all cutting me loose with absolutely no concerns when my nodes are hitting every criterion for more testing?
Yeah I reviewed the chart too and I can’t find the 2cm one but there were several in the anterior cervical chain (where my palpable ones are for the most part that and my left jugular nodes and under my chin) that had diameters of 1.2 etc and that’s short axis as well.
I guess I just don’t understand why there isn’t more concern without any explanation, even the hematologist said they thought the odds of cancer were “less than .5 %%” and I’m assuming they reviewed my ultrasounds as well. I know they had access to it, so are small swollen nodes with no explanation just not concerning to doctors or something? I have some over a centimeter I have over a dozen now palpable that never used to be just over a year ago, I have two tiny ones that feel stuck together however those I admit I had years before the new ones, even if they show hilum why wouldn’t there be more concern?
I have a couple palpable submental nodes that are new in the last year, the submandiblur are the one cm’s from what I understand, both the anterior and posterior chain on my left side are completely swollen, I can palpate several along each chain. As well as one on my spinal accessory nerve (far back to the left side under where the skull meets my neck. It’s pretty widespread.
I should also mention that I’ve read posterior cervical nodes are much more likely to be malignant when enlarged..is that true? Because the whole posterior chain is swollen on me. Small yes but still they were the first ones I noticed, as well as two in the anterior chain along the jugular, one on the spinal cervical and two under the jaw. Why is posterior more concerning?
https://www.medscape.com/answers/956340-53135/what-is-cervical-lymphadenopathy#qna
Regarding the posterior group
1081992 tn?1389903637
COMMUNITY LEADER
"Ultimately though my sizes aren’t concerningly large though?"
The are not near to where one would think that a cancer is the likeliest explanation.

"I’m assuming the very long period of no growth would also be a bigger indicator eliminating the potential ‘false negstives’"
Yes, quite true. A cancer would have had to stop growing, lying dormant now after having been more aggressive. Very improbable.

"That also concerns me though because it says small nodes should be considered for the fact they can contain malignancies that ‘do not expand the node’ is that saying that there are cancers that just wouldn’t grow the node over time?"
I would take it more that a small node cancer is just beginning to grow and would be larger when scanned again later. But that small node cancer would still tend to be rounded.
Helpful - 0
1081992 tn?1389903637
COMMUNITY LEADER
Thanks, and a [belated] Merry Christmas to you, too!

Let's try a few:

"The largest node in my upset neck almost under my chin is 1.4 centimeters long and .4mm in diameter."
Cancer makes nodes go toward roundness, so therefore that very long and thin node seems fine. When cancer cells proliferate, they go willy-nilly in all directions at once; but normal cells proliferate in a controlled manner.

"So basically is being basicall 1.4 centimeters ‘tall’ as she put it, concerning or can nodes under the jaw normally be that large?"
Reactive nodes are 'normal'. Now, just to show how terms are confusing,  reactive nodes fall also under 'lymphadenopathy' even though there is no pathology as in 'abnormal'.

A reactive node can certainly be normal at 1.41cm length, yes. Maybe 2cm and more. (But check this, just show how things can vary and there is no hard limit: I'd once read a paper which showed than reactive nodes in Brazil get longer than in other countries.)


Look here at Figure 1, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5073388/

The long axis is called 'largest diameter'. Other authors use 'diameter' as meaning short axis. Some say the upper limit for neck short axis is 1cm, some say it is 1.5cm. (Inguinal is generally bigger.)



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1081992 tn?1389903637
COMMUNITY LEADER
"Because the radiologist report said even the nodes over a cm in long axis (a handful of them) weren’t considered enlarged so I don’t understand how that could be."

Does it say "not enlarged", or does it say "not pathologically enlarged" or "not abnormally enlarged"?
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2 Comments
So I guess I’m wondering is 1cm in the long axis something that can be ‘original from birth’ so to speak? Because she said I have a couple in the right side as well and I have no new (or at least noticeably new) enlargement at that side at all. Shr said the report found “completely normal lymph nodes, no evidence of reaction or malignancy, the nodes of the left side were ‘more prominent’ (the recurring term they used for them never enlarged) but slightly less prominent than last time.  So I guess I’m just confused by this, I’ve heard many doctors say after reviewing the notes in the past I have no nodes over a cm, yet these radiologists have access to my previous ultrasounds and say there is no growth at all infact some shrinking, so we’re those doctors just not reading the full report or just using the diameter basis? Are my nodes considered ‘abnormal’ in the length of some of them even if not abnormal in a worrying way? I’m just curious here.

I should also mention I have calmed down quite a bit, in my journey over the last year to find answers a lot of the doctors and nurses and even the radiologist PA on the phone mentioned they’ve had lymph nodes pop up after bad infection and stay enlarged to this day, she even said one of hers was 1.6 cm in tall axis but assured me that short axis is what is considered concerning. So it seems like this is somewhat common and probably very much intensified by my health anxiety. That in with how long it’s been even something slow most likely would have at least grown.

Still I’m just curious if having a handful of 1.2-1.4 cm lymph nodes is something worrisome or just natural anatomy, it does sound like most of them are in the upper neck/jaw region that size which I know I’ve read are normally larger compared to nearby regions.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5073388/

This too kind confused me, this was a study of lymph node findings is assuredly healthy people and (correct me if I’m wrong it is a little above my understanding) it’s find multiple nodes over 2cm in the neck? Considered normal? Even nodes over a cm in diameter? Or am I misunderstanding this study?
1081992 tn?1389903637
COMMUNITY LEADER
It turns out that your own cite handles the question of size quite nicely:
https://www.ajronline.org/doi/pdf/10.2214/AJR.12.8960
It's about head and neck cancers, not lymphoma, but still applies.

"Evaluating abnormal nodes by size is confusing because there are multiple size criteria reported in the literature for cervical lymph nodes..."

"In clinical practice, size is not a reliable marker of malignancy."

But there's a lot more to be garnered from that article than just those conclusions. E.g., when they talk about sensitivity versus specificity - that really gets to the heart of most of these questions of yours. IOW, if you set the size limit too low, you get too many false positives. If you set the size limit too high, you get too many false negatives. The grand lesson: overall, the size limits are not something set in stone anyway.

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2 Comments
Ultimately though my sizes aren’t concerningly large though? I’m assuming the very long period of no growth would also be a bigger indicator eliminating the potential ‘false negstives’ Of the smaller nodes given they would have grown larger in said time?

Merry Christmas by the way!!
That also concerns me though because it says small nodes should be considered for the fact they can contain malignancies that ‘do not expand the node’ is that saying that there are cancers that just wouldn’t grow the node over time? Wouldn’t lymphoma or something slow growing always increase a node over time? I don’t understand what it means by that and that is what has me concerned.
Avatar universal
Here was the other article I mentioned about how occasionally lymph nodes remain permanently enlarged but should be under a centimeter in size; https://meded.ucsd.edu/clinicalmed/head.htm

Are they referring to short axis? Is that the ‘default’ measuring parameter so to speak or are they saying long axis as well?
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Avatar universal
I mean I read articles like this regarding sizing; https://www.ajronline.org/doi/pdf/10.2214/AJR.12.8960
And I read other articles saying ‘any node larger than 1cm is considered abnormal’ and it has me concerned again. When they say larger than 1 cm are they always speaking in terms of short axis or how ‘fat’ a node is? Is the long axis of 1.4 cm truly abnormal? Because the radiologist report said even the nodes over a cm in long axis (a handful of them) weren’t considered enlarged so I don’t understand how that could be.
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Avatar universal
I guess I should also ask if that .7 lymph node would be concerning? Assuming it was measured short axis and she didn’t mean long axis. That’s pretty close to the centimeter mark
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