Resolved question:
Hallo Doctor,
Back in September 2014 I noticed an enlarged lymph node on the left side of my neck located a little over 3 inches down from the ear lobe and slightly behind (which most likely makes it a posterior cervical lymph I think - on the neck, but not far from the edge of the trapezoid muscle). My guess is that it's been around 1 cm, maybe slightly bigger. No idea how long I might have had it. Feels movable, slightly ellipsoid / elongated, and usually not tender, but it's been tender on occasion. I honestly don't know if it has grown since then or not, but it's been definitely visible through the skin in certain neck positions (which of course, the OCD that I am, convinces me that it has grown). I also think it may vary slightly in size, feeling, or tenderness depending on time of the day, stress level, etc., but that's too subjective obviously.
Worried about it, I looked for a "similar" sized node on the right side to justify the existence of the one on the left side. I did find one, albeit smaller and less noticeable (<1 cm), and a little deeper into the neck, at about the same ~3 in vertical distance, but at the level of the ear lobe, not behind it (i.e., the middle of the right neck side). If I never got worried about the left one, I would have totally ignored the right one as it does feel normal more or less.
Since September:
- In December, I saw a primary care doctor who did standard blood work (CBC, CMP, TSH), chest X-ray, and soft tissue x-ray on neck, all came back "normal." Doctor said to not worry about it, it's likely a fibriotic clogging / left over virus clogging, or cat scratch fever. I wasn't convinced, and suggested we do biopsy, but he said he was certain one was not needed.
- In early February (last week), I saw another primary care doctor as I am still very concerned. I don't think the left one has grown in size, but it has definitely "grown" in my mind in terms of awareness and visual discomfort, which somehow makes that part of the body more sensitive all around - nech side, shoulder, along the arm, etc. (you know that OCD feeling that something is "wrong" in that part of the body). Doctor was a little concerned as the left one has been there for many months now, and the second one, albeit smaller, is there too. He referred me to ENT doctor for biopsy as this is the only way to really know what's happening. He said this is an unlikely spot for left-over respiratory clogging, although he didn't rule out the cat scratch bacteria.
About me: Healthy, fit 34 year old male, no history of any serious disease.
- I have had chronic sinus and left ear infections on and off (left year infections have been sometimes very persistent, not sure if it's been bacteria or fungus)
- Mild inverse psoriasis (shows up occasionally around inner thigh / groin and neck area)
- Very allergic to cats, and have been exposed to cats 6-7 times over the last 6 months (touching, potential licks or minor scratches possible) as well as for 1 year continuously back in 2007/2008.
- In early 2014 I had a really nasty staph infection on my nose that went for 2 weeks, and involved strong fevers and huge amount of pus (at some point, I could squeeze out 10-20 mL). I was given strong antibiotics that took care of this, but this was the sickest I have been for many years.
No other symptoms of any kind - no fatigues, sweats, headaches, or spleen pain, STDs/HIV, etc.
Questions:
1) I know this is an alarming situation, so how likely is for this case to be lymphoma? Obviously "normal" CBC blood work doesn't mean anything at this point. It's kind of disturbing to know that absolutely no symptoms could still mean you have the disease, although it would likely mean it's in early stages I am assuming.
2) How likely is this to be a neck / head / throat cancer of some sort? Would the fact that my soft-tissue X-ray of the neck came back "normal" rule out this scenario?
3) Are there other, benign reasons for this? Are there any statistics of malign vs. benign outcomes in these unusual lymph places? At this point, are the statistics in favor or one or the other? I read that inflammations or prior infections could keep 1-2 lymph nodes on for a long time, but how likely is this here?
3) During my ENT appointment, I will be definitely insisting for a biopsy, and I assume the ENT would agree. Are there any other tests that can be done before that for guidance?
Thank you for any insights. Needless to say, I am quite worried.
Regards,
Ves
Submitted:
4 Days
Category:
ENT Specialist
Hello,
Thank you for your query at DoctorSpring.com
I can understand your problem.
You are suffering from neck node from 6 months, as it is not increasing in size significantly I think you need not worry about cancer or lymphoma, but we can follow investigation protocol used for node of more than one cm.
-USG neck
-Endoscopy of nose and throat
-FNAC and biopsy can be done following that as it will give a definitive diagnosis, and it is very small procedure, so it will help in relieving all your stress.
Hope this helps,
Best regards
Dr. Sunil Jalan
MBBS, DLO,MS(CMC,VELLORE)DNB(ENT),DAA,MBA(HM)
Dr. Jalan, thanks for the response. I you could, will you please specifically provide a comment for Questions 2 (significance of "clean" X-rays) and 3 (possible benigh reasons for this given my history)?
Thank you,
Ves
Hello,
Xray neck lat view gives very little information, so even with a normal x-ray neck lat view we need further investigation.
A CT scan of neck gives more information about size and shape of neck nodes.
Your nodes are most likely benign only, most common cause is any recent infection of head and neck or throat ( pharyngitis, laryngitis, even pediculosis). Next it may be tubercular but malignant with this presentation without any fast increasing in size is very unlikely.
Hope this helps
Best regards
Dr. Sunil Jalan
MBBS, DLO,MS(CMC,VELLORE)DNB(ENT),DAA,MBA(HM)