Biopsy/surgery in case of Lymphadenitis

[franzderkaiser]

Is biopsy/surgery a must in case of acute Lymphadenitis (undefined) for a 35 years old female patient?
My neigbour is anxiously seeking for an advice. She has several blood tests, MR, Ultrasound tests done.
This is my first post; I appreciate much any response.
Thanks a lot in advance!

[mkh9]

I hope it is helpful. Let me know how it goes.
take care,
mkh9

[franzderkaiser]

I thank you very much for your patience and detailed explanations!
It has been a great help and has also been much more than I expected.
Thank you, in the name of the family also!
Best regards

[mkh9]

Well, the results are similar but she also may have anemia. It is complicated. I am not a doctor. I think that since there is evidence of some type of mass and they don't know what it is and there is a positive toxoplasma. The scans show that she needs a biopsy and that is confirmed by the lab work. So, at this point She should get a biopsy of at least one of the suspected masses to see what is going on. I can't say which one or how many because I am not a doctor. But I can agree this time with the doctor that the biopsy does need to be done. So it is up to the doctor to decide where to take the biopsy. The lab pathologist will give more results on what is present. That will help determine the treatment. i don't know if surgery is required rather than treatment. But I don't know if it is the toxoplasma causing this until they biopsy and/or do further studies. I wouldn't removed all nodes. Not unless she had a diagnosis of cancer then they usually do chemo or something like that or other treatments. So, I would wait until they determine from the biopsy if it is toxoplasma causing this and see if they can treat that without surgery. If the biopsy turns out it is something else then that is another matter. She may also want to get tested for anemia because her RDW is high and that may indicate iron deficiency. So getting the iron and ferrrtin tested would be good.
The kind of biopsy is giong to have to be up to the doctor. You may want to tell them to see either a hematologist or an infectious disease doctor.

take care,
mkh9

[franzderkaiser]

well, as far as I could see, the results seem to be similar, but I am not sure. So I better copy and paste the oldest results here.

2013-06-24 Test Results:
Test Name   Patien’s Results Key Ref.Range Units
Biochem.Serology
CRP 0,02 0-0.8 mg/dL

Test Name Patien’s Results    Key Ref.Range Units
SEDIMENTATION 21              H 5-15

Test Name Patien’s Results Key Ref.Range Units
HEMOGRAM
WBC 6.2 4.5 -10.3 K/UL
RBC 4.09    L 4.30 - 5.77 M/uL
HGB 12.7 11.0-17.2 g/dl
HCT 36.9 36.0-50.3 %
PLT 145                L 156 - 373 K/uL
MCV 90.2 80.7 - 95.5 fl
MCH 31.1 27.2-33.5 pg
MCHC 34.4 32.7-35.6 g/dl
MPV 10.8                H 7.4 -10.4 a
PCT 0.155 %
PDW 16.8 %
LYM 3.3 1.3-3.5 K/uL
LYM% 52.2                H 20.0 - 44.0 %
BASO% 0.4 0.3-1.5 %
BASO 0.0 0-0.2 K/uL
EOS% 0.5                L 0.9 - 4.0 %o
EOS 0.0 0.0-0.5 K/uL
NEU% 38.5               L 50-70 %
NEU 2.4 2.1-6.1 K/uL
MONO% 8.4 5.1-9 %
MONO 0.5 0.3-0.8 K/uL
RDW 13.6               H 11.8 -13.4 %

and 2013-10-25 test results as follows:

CRP 0,06 0-0.8 mg/dL
RF 14 0- 14 IU/mL
ASO 105 0-200 IU/mL

WBC 6.0 4.5 - 10.3         K/uL
RBC 4.09 L 4.38 - 5.77 M/uL
HGB 12.4 11.0 - 17.2 g/dL
HCT 37.7 36.0 - 50.3 %
PLT 195 156 - 373 K/uL
MCV 92.3 80.7 - 95.5 fL
MCH 30.3 27.2 - 33.5 pg
MCHC 32.8 32.7 - 35.6 g/dL
MPV 8.5 7.4 - 10.4 fl
PCT 0.165 %
PDW 17.4 %
LYM 2.7 1.3 - 3.5 K/uL
LYM% 45.2 H 20.0 - 44.0 %
BAS0% 0.9 0. 3 - 1.5 %
BASO 0.1 0-0.2 K/uL
EOS% 0.3 L 0.9 - 4.0 %
EOS 0.0 0.0- 0.5 K/ul
NEU% 46.5 L 50-70 o/o
NEU 2.8 2.1 -6.1 K/uL
MONO% 7.1 5.1-9 %
MONO 0.4 0.3 - 0.8 K/uL
RDW 13.7 H 11.8 - 13.4 %

again, sorry for the mess of the table. If it is not too much for your opinion, I'd send other results from 2014, or any other results from my first list of results. I'll see the family today, and will speak with them. She's quite uncomfortable with the idea of any surgery.If biopsy, which kind, and remove all node?
Thank you for your care!

[mkh9]

p.s. regarding toxoplasma when I say past infection I think in this person's case she had it for several years it looks like so that would be a past infection or an infection she got long enough in the past that the IgG would be positive and the IgM to be negative.

Also, most people who have toxoplasma don't have symptoms and those that get severe symptoms may have other underlying problems.I just looked up info regarding toxo. So if you have it you usually don't get rid of it on your own and it can cause cysts with the parasite in it and it can spread in the body. See the link. So maybe the nodules they found are toxoplasma. I would get them biopsied and also get treated for toxoplasmosis. The reason I would get the biopsy is to make sure there is nothing else going on too and to confirm that is what they are.

http://www.ccohs.ca/oshanswers/diseases/toxoplasmosis.html

regards,

mkh9

[mkh9]

Well on the test from 1/16 the Lymphocyte percentages,and monocytes were high but the Neutrophils (white blood cells) were low. Also, on 4/15 the results are normal.

the Toxoplasma is past infection as the IgM is normal. I have to look up whether Toxoplasma resolves on its own or not.

As positive ultrasounds and other scans they seems to still show a positive mass over time that isn't going away. Were the blood tests in the past 2013 and 2014 also the same as the one on 1/16 where there where high lymphcytes and monocytes and low neutrophils? If so then there is a pattern except for the current blood test on 4/2015. It looks like the person need to have that biopsy done if the results are still the same. The only thing that has changed is the complete blood count is normal. Which is really good but not sure whether it is transient or what.
mkh9

[franzderkaiser]

Well, here is 2015-01-16 Hemogram results:
Hemogram (second column shows normal ranges)
WBC 4,5 4 - 10.5 K/uL
RBC 4,25 4.2 - 5.4 M/uL
HGB 13,29 12.5 - 16 9/dL
HCT 39,5 37-47 %
PLT 173 156 - 373 K/uL
MCV 93 78 - 100 fL
MCH 31,27 H 27-31 P9
MCHC 33,66 32.7 - 35.6 9/dL
MPV 10,4 7.4 - 10.4 (L
PDW 19,8 %
LYM# 2,27 1.5 - 3.5
LYM°/o 50,3 H 20.0 - 44.0 »/o
BAS# 0,06 <0.1 K/uL
BAS0% 1,4 0.3 - 1.5 %
EOS# 0,04 <0.7 K/uL
EOS% 0,9 0.9 - 4.0 %
NEU# 1,62 1.5 -6.6 K/uL
NEU% 36 L 50.0 - 70.0 »/o
MON# 0,51 <1 K/ul
MON°/o 11,4 H 5.1 - 9.0 «/o
RDW 12,4 11.5 - 14 %

And here 2014-04-15 complete blood test results:
Test Name    Parameter    Result   Normal    Ranges    Unit
ALANIN AMİNOTRANFERSE (ALT) (SGPT) ALT- SGPT 22 0-55 U/L
COMPLETE BLOOD COUNT AUTOMAT. (MINIMUM 18
PARAMETERS)
LEUKOCYTE ( WBC ) 6.91 4.00 - 10.50 K/uL
LYM 3.22 1-3.4 K/uL
MONO 0.561 0-1.0 K/uL
GRA 3.13 2.5 - 7.5 K/uL
LYM% 46.5 0-99 %
MONO % 8.12 0-99,9 %
GR% 45.32 42.2 - 75.2 %
NE 2.99 2-6.9 K/uL
NE% 43.3 0
- 99,9 %
BASO 0.109 0 - 0.25 K/uL
BASO% 1.57 0 - 99,9 %
EOS 0.031 0.0 - 0.50 K/uL
EOS% 0.452 0.0 - 99,9 %
ERYTHROCYTE ( RBC ) 3.99 A 4.0 • 5.5 M'uL
HEMOGLOBIN (HGB) 12.4 12-16 g/dl
HEMATOCRİT ( HOT ) 37.6 35-47 %
MCV 94.1 75 - 100 fL
MCH 31 25-33 pg
MCHC 33 31-36 g/di
ROW 14.8 11-20 %
PLT ( THROMBOCYTE) 203 150 -500 K/uL
PCT 0.166 0,150 - 0,500 %
MPV 8.17 6-15 fL
PDWc 17.4 11-50 %
TOXOPLASMA Ig G TOXO IGG Positive NEG8,8
PATIENT'S 87 •
TOXOPLASMA Ig M TOXO IGM Negative NEGPOSITIVE İNDEX
PATIENT'S 0.06
Page 1/1
terribly sorry for messing the table format; this is what I could fix.
Thank you for your understanding!

[mkh9]

p.s. please include normal ranges for the blood test. All in English if possible.
thanks,
mkh9

[mkh9]

You can just send the most recent complete blood count and copy here.
mkh9

[franzderkaiser]

Thank you for your further comments! I'd give the test results, but it'd be a very long list; so I thought I'd attach the files to e-mail. Or preferebly copy and paste here?
Thank you!

[mkh9]

So, it sounds like the toxoplasma IgM result was slightly positive. Which is usually current infection. Was the IgG also positive? So the question is since it is slightly elevated is this causing the problem or is there a bigger problem.

Besides handling cats and cat litter (feces) you can also get it by food and water that is contaminated with toxoplasma.


The Leukemoid reaction can be related to a few things on the ultrasound and so can the 7/17 ultrasound that said hypoechogenic mass. Those things need to be checked out with a biopsy I think.

What does the white blood cell count and lymphocyte count look like? Why don't you give me the complete blood count if you have that.

I think you/ this person needs to have the biopsy and needs to follow up with this.

But I will be glad to look at any lab results.

mkh9

[franzderkaiser]

2015-01-16 test toxo IgG_IgM CMV IgG_IgM results
P.S.:All test results translated by me into English and are available upon request.
(This last part I failed to copy and send. Sorry!)

[franzderkaiser]

Thank you again for your prompt response; this is very nice of you.
I tried to put some data in chronological order as follows. I can email the English versions of these results any time.
=====================================================
2013-06-24 first test on lympfadenopathy incl. full blood test
2013-06-26 one ultrasound test: 10x17mm oval hypoechoic LAP reported
2013-06-28 another ultrasound test with18x9mm hypoechoic LAP reported, evaluated as a reactive LAP,
2013-10-01 blood test hematology results with WBC/RBC/HGB/HCT/PLT/MCV/MCH/MCHC/MPV, ALT/AST..etc.
2013-10-25 similar blood test as above
2013-11-01 another ultrasound test with 13.8x8.66mm reactive lymph node reported.
2014-02-27 similar blood test hematology results as above
2014-03-19 Test rubella IgM toxo IgM CMV IgM  with
Rubella IgM 0,396 Nonreactive (normal 0.00 - 0.99) COI
Toxo IgM 1/11 Pozitif     (normal 0.80 - 0.99) COI
CMV IgM 0,307 Negatif          (normal 0.70 - 0.99) COI
and MONO TEST NEGATIVE
2014-03-20 BETA-HCG : 0,1 (Normal:0-5 mIU/ml)
2014-03-28 Upper abdomen ultrasound test indicating 17cm of right lobe of liver only; nothing significant reported
2014-04-07 biochem. test Toxo IgM 1,09 Pozitif (normal: 0.80 - 0.99)
1 hr. sedimentation: 12 (normal 5-15)
2014-04-07 Hemogram test results
2014-04-15 Full blood test results
2014-07-17 another ultrasound test; "left parotid gland  reported a 20x12 mm size solid hypoechogenic mass observed (LAP? Parotid gland mass?) (asks the doctor)
In the left upper jugular chain a 9x6 mm size round lymphadenopathy were observed."
2015-01-16 Hemogram test results.
This is the actual stand of this case.
Thank you!

[mkh9]

Well, that is good it doesn't sound like TB or infection at this point. Did the ultrasound or MRI show any thing? Does the person have a cat or dog? Toxoplasmosis can often come from a cat or animal. What other tests were done? I can try to take a look at the results but I may or may not be able to read them. Did this person have swollen lymph nodes and where were the swollen lymph nodes located?
thank you,
mkh9

[franzderkaiser]

Thank you so much for your post
and your good intention to help!
The patient has no high fever, slightly coughs currently; claiming that it'd come from cold, no problems with aspiration, no nught sweats. No high white blood cell count (last reported WBC 4.5 (normal:4-10.5)
According to one doctor the infection might be triggered by toxoplasma.
Related to the disease I received 17 test results including 4xultrasound tests and one MR test from the patient (translated into English) available upon request.
I now seek an advice based on these test results how to proceed.
I'd appreciate any further help

[mkh9]

Firstly, we are not doctors on here. But I am a microbiologist and can try to give you advice. It really does depend on the situation. Lymhadenitis can be caused by a lot of things. Does this person have a high fever? Have they trouble breathing or coughing? Night sweats? Do you know if the white blood cell count is really high?

They may want to biopsy to see what the cause is. I can't see why they would do surgery without finding out the cause unless it is an emergency where she can't breath or has a blood infection and something like that. Did they see anything on the Xray, MRI? etc.

This is a link that explains some of the things they look for in this type of problem:

http://www.healthgrades.com/conditions/lymphadenitis

So they mention that Staph and Strep types of bacteria can cause this as well as TB and other things.

Does she have a sore throat with pus? Any other symptoms?

Thank you,
mkh9