Aa
Should I have further teats?
Hi; I am a 52 year old female, with an enlarged painless groin node. At first scan, four weeks ago, it was 2.7 cm, and radiologist was concerned and suggested biopsy. Second scan, by same radiologist at six weeks, the node had grown to 3 cm, and she said it was "suspicious" looking, and that it was NOT reactive. One week later, I had a needle core biopsy done, because this was deemed ASAP, and the radiologist at the hospital said it was very suspicious, and that it had grown some more, and he said I should prepare myself for bad news. One week and one developing ulcer later, I called my doctor's office this morning, and was told that they had reviewed the results and everything's great, nothing's wrong, don't be concerned.....well that is wonderful news that the needle core showed no malignancy, but how about WHY DO I HAVE A NODE ON MY THIGH THAT CONTINUES TO SWELL? My doctor considers this normal? I made an appointment to discuss this with her, and I would like to know what I should ask? Should I just accept that I have a group of enlarged nodes and one is over 3cm? If that is normal I will accept that and be grateful for no malignant cells, but having them there makes me nervous. Thank you for your time.
COMMUNITY LEADER
summary: something was effacing the fatty hilum, and that is usually cancer. But with you, it likely wasn't cancer because only inflammatory cells were found there. Raging inflammation is the only other cause of effacing the fatty hilum that I know of.
No one knows for sure that there is no cancer. The only way to know is the full resection, which carries risks of problems.
Also, remember that a cancerous node can look like cancer to the naked eye during surgery. That's especially true for a big node if the cancer has grown right through the outer boundary.
But your node might somehow just be overly stuffed with non-cancer cells.
No one knows for sure that there is no cancer. The only way to know is the full resection, which carries risks of problems.
Also, remember that a cancerous node can look like cancer to the naked eye during surgery. That's especially true for a big node if the cancer has grown right through the outer boundary.
But your node might somehow just be overly stuffed with non-cancer cells.
COMMUNITY LEADER
Hiya, well now we know that partial loss of the fatty hilum is indeed a big reason why the radiologist was alarmed. But take a moment to quickly remember that the fatty hilum can still be effaced (wiped out) by an unusual, powerfully destructive but non-cancerous condition like inflammatory pseudotumor.
A "full metastatic work up" means that if there is reason to suspect that the big groin node is metatstatic, then more scans (such as CT scans) should be done on the abdomen, chest, bones, etc to look for more. Your doc probably would have ordered those if your biopsy had turned up metastatic cancer cells. But such cells didn't turn up, so it seems you are always one way and then the opposite way - which is very good to not be diagnosed with cancer but is unusual so that still keeps up the mystery.
Curiosity you say? :) This paper can tell you a lot:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC534446/
"Groin dissection is associated with high postoperative morbidity, chiefly related to wound healing and lymphoedema"
which would be one reason to do the needle biopsy instead of plunging in with the open (aka resection aka excisional) biopsy. Morbidity = problems.
"Malignant tumours of the skin, most commonly malignant melanoma or squamous cell carcinoma arising on the legs and trunk, may metastasise to the inguinal lymph nodes."
So that's why they were thinking of those two causes (especially melanoma if you are fair skinned).
But why did they seem to not ever be thinking of lymphoma? I don't know, unless the big node was harder than they would suspect of lymphoma. (Metastasis is usually harder.)
"It is relatively uncommon to have an unknown primary lesion manifest as a palpable metastatic inguinal node." So for your big node, on its own with no other known cancer, being a metastasis would be unusual. So that's in your favor and also the biopsy said they stained for carcinoma and found none.
"Outpatient pathological sampling of a palpable lymph node is performed by fine needle aspiration cytology... Open biopsy of enlarged lymph nodes should be undertaken by specialist surgeons only..."
But if the needle in the big node had cancer in it, they would have then probably surgically took it out and also took out any other enlarged nodes and maybe some nodes that were just nearby - as a precaution.
So why was your biopsy guided? Usually they just poke the needle at several places. So I'd guess they guided the needle right to the suspiciously effaced hilum. But they found no cancer there, only some remaining fat and also some inflammatory cells.
Now how reliable is finding no cancer via needle?
"The utility of fine needle aspiration in the diagnosis of melanoma metastatic to lymph nodes"
http://www.ncbi.nlm.nih.gov/pubmed/9091471/
which says that "(89%) yielded a definitive diagnosis"
So that's in your favor, provided the extracted sampke was adequate - and you had the bigger needle than the Fine Needle Biopsy, even though the report said the sample was small.
So where does that leave you? We still don't know, but we now know most of their thinking process and it's looking very possible that you don't have cancer. BUT they still have no reason to just drop things completely and say not to worry.
Can you feel any of the other nearby nodes that they mentioned? If they move independently (not being "matted") that's a good sign.
A "full metastatic work up" means that if there is reason to suspect that the big groin node is metatstatic, then more scans (such as CT scans) should be done on the abdomen, chest, bones, etc to look for more. Your doc probably would have ordered those if your biopsy had turned up metastatic cancer cells. But such cells didn't turn up, so it seems you are always one way and then the opposite way - which is very good to not be diagnosed with cancer but is unusual so that still keeps up the mystery.
Curiosity you say? :) This paper can tell you a lot:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC534446/
"Groin dissection is associated with high postoperative morbidity, chiefly related to wound healing and lymphoedema"
which would be one reason to do the needle biopsy instead of plunging in with the open (aka resection aka excisional) biopsy. Morbidity = problems.
"Malignant tumours of the skin, most commonly malignant melanoma or squamous cell carcinoma arising on the legs and trunk, may metastasise to the inguinal lymph nodes."
So that's why they were thinking of those two causes (especially melanoma if you are fair skinned).
But why did they seem to not ever be thinking of lymphoma? I don't know, unless the big node was harder than they would suspect of lymphoma. (Metastasis is usually harder.)
"It is relatively uncommon to have an unknown primary lesion manifest as a palpable metastatic inguinal node." So for your big node, on its own with no other known cancer, being a metastasis would be unusual. So that's in your favor and also the biopsy said they stained for carcinoma and found none.
"Outpatient pathological sampling of a palpable lymph node is performed by fine needle aspiration cytology... Open biopsy of enlarged lymph nodes should be undertaken by specialist surgeons only..."
But if the needle in the big node had cancer in it, they would have then probably surgically took it out and also took out any other enlarged nodes and maybe some nodes that were just nearby - as a precaution.
So why was your biopsy guided? Usually they just poke the needle at several places. So I'd guess they guided the needle right to the suspiciously effaced hilum. But they found no cancer there, only some remaining fat and also some inflammatory cells.
Now how reliable is finding no cancer via needle?
"The utility of fine needle aspiration in the diagnosis of melanoma metastatic to lymph nodes"
http://www.ncbi.nlm.nih.gov/pubmed/9091471/
which says that "(89%) yielded a definitive diagnosis"
So that's in your favor, provided the extracted sampke was adequate - and you had the bigger needle than the Fine Needle Biopsy, even though the report said the sample was small.
So where does that leave you? We still don't know, but we now know most of their thinking process and it's looking very possible that you don't have cancer. BUT they still have no reason to just drop things completely and say not to worry.
Can you feel any of the other nearby nodes that they mentioned? If they move independently (not being "matted") that's a good sign.
Oh yes, and not in the report, but just part of our discussion as she scanned, she asked me if I have ever had melanoma. (No.) So whatever she was looking at was raising some flags to her.
Hi Ken, I got hold of my U/S reports today. There is nothing in either one about "effacing". However, the radiologist did say that she wanted me to have a "full metastatic work up", and to my knowledge I have not had that. I have had just the routine blood tests.
In both reports, she states that there are a few enlarged groin nodes associated with the loss of hilar fat in the medial aspect.The second scan showed the node had grown to 3.0x1.0x1.7cm. In this report she advsied needle biopsy.
Okay, just because I am going to pretend nothing is wrong, doesn't mean I am not still curious!
In both reports, she states that there are a few enlarged groin nodes associated with the loss of hilar fat in the medial aspect.The second scan showed the node had grown to 3.0x1.0x1.7cm. In this report she advsied needle biopsy.
Okay, just because I am going to pretend nothing is wrong, doesn't mean I am not still curious!
Thank you for your opinion. I am definitely going to go ahead with the biopsy, as this was what I thought I was headed for weeks ago anyway. Unfortunately, I have to wait until July for a surgical consult, which will probably mean August for the biopsy. Yes....sadly that is ASAP here. (There are too many sick people.)
And I cannot live stressed like this until then, so I am going to go to my happy place in my head and pretend that all is well. I have to continue to live. Continue to work, work-out, parent, be a wife.....the stress of not knowing anything is literally making me sick. I won't know anything for weeks and weeks, so I am going to pretend that I am fine.
I am glad to hear that you are in remission, but saddened that you have had to deal with this twice.
And I cannot live stressed like this until then, so I am going to go to my happy place in my head and pretend that all is well. I have to continue to live. Continue to work, work-out, parent, be a wife.....the stress of not knowing anything is literally making me sick. I won't know anything for weeks and weeks, so I am going to pretend that I am fine.
I am glad to hear that you are in remission, but saddened that you have had to deal with this twice.
Hi S I live in the UK and have had hodgkins lymphoma twice, I am currently in remission.
The needle biopsy here is really used by surgery to see if squamous cell is present, that means they cannot cut into the enlarged node as it will go everywhere, to quote my surgeon.
It is generally not considered an acurate way of detecting lymphoma by my oncology Consultant and neither is a bone marrow trephine.
They just indicate irregular cell activity.
A biopsy is the only trusted way to diagnose lymphoma and is usually followed by a PET scan for staging, or to see the extent of progression.
So you should press for a biopsy in my opinion.
The needle biopsy here is really used by surgery to see if squamous cell is present, that means they cannot cut into the enlarged node as it will go everywhere, to quote my surgeon.
It is generally not considered an acurate way of detecting lymphoma by my oncology Consultant and neither is a bone marrow trephine.
They just indicate irregular cell activity.
A biopsy is the only trusted way to diagnose lymphoma and is usually followed by a PET scan for staging, or to see the extent of progression.
So you should press for a biopsy in my opinion.
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