Precarinal Lymph Node

[Rick905]

CT scan results: 1.5mm calcified pulmonary nodule right upper lobe of lung,with minimal atelectasis or pleural thickening along right middle lobe.There is no axillary or mediastinal lyphadenopathy although a precarinal lymh node measuring 12x6cm is seen. there is no pericardial effusion.The spleen is enlarged measuring 16cm.Is this somthing I should be concerned about.

[HeinrikMD]

Hi,

If the node doesn’t seem to be causing any of the symptoms, it is possible to observe it. You could consider performing serial CT scans or serial PET (if this is available to you).

Another thing to consider is performing blood tests such as alpha fetoprotein and beta-HCG. The node may represent a germ cell tumor, and these tumors tend to release the 2 blood elements mentioned. Germ cell tumors are worthwhile to investigate as they are curable tumors.

Discuss what options are available to you with your doctor and post them, and I may be able to shed some light.

Stay positive.

[Rick905]

Thanks for your reply.  No night sweats, fever or loss of weight.  I talked with my internist via the phone the other day, he did not seem concerned and only suggested that I continue on a low fat diet because of the fatty infultration of the liver which I have had for 20 years.  I quit smoking 4 years ago and I do not have a cough or any past lung problems.  The reason for the CT Scan was that I was having a burning pain in the left upper part of my chest.  Chest exrays were negative, blood work was fine.  I do have high blood pressure and acid reflux which I take medications for.  I am a 47 year old male, 6.2, 245 pounds.  I have made an appointment to see my internist next week.  Should I, in your opinion, request a biopsy of the lymphnode?    Thanks again, Rick.

[HeinrikMD]

Hi,
Do you have any symptoms? Cough? Easy fatigue? Do you look pale? How old are you? Are you a smoker? If you were a smoker how long ago have you stopped smoking?
The finding in the lung is not particularly high-risk based on its features, but if you are a heavy smoker and you are more than 60 years old, it might need to undergo a biopsy or be watched with subsequent scans with close intervals. This is we consider the hilar nodule as suspect for lung cancer.
The presence of the precarinal lymph node though makes me think this may not be lung cancer but be a primary disease of the lymph nodes such as a lymphoma. Do you have fever? night sweats? loss of weight? Its size would warrant a biopsy. The risk of the biopsy is offset by the good chance of cure for lymphoma. If you are male, another consideration is a germ cell tumor - which would have a good shot at cure as well. So for this, it may be best to check it out.
The finding in the spleen may be related and increases the chance of this being lymphoma. Perhaps it would be a good idea to discuss this with your doctor.
Stay positive.