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Can you help me understand my ultrasound results?

Hello
About 2.5 months ago i noticed a large lymph node in my groin area. I had a lot going on but made a mental note to keep an eye on it. Then one day last week i noticed it had gotten bigger. I visited my gyn. I expected her to give me antibiotics but instead she made an appointment for an ultrasound and a surgeon. I had my ultrasound yesterday and the result is:

FINDINGS:  
3 x 1.6 x 0.7 cm hypoechoic lymph node is noted.  
IMPRESSION:  
borderline enlarged right inguinal lymph nodes.  Clinical correlation is recommended.  

From what I gather the oval is a good shape but the hypoechoic may be worrisome?

I have been fatigued for several months. I did have a period of night sweats for about 6 weeks but that has not happened in about a month or so.

the appointment with the surgeon isn't until mid next week and i'm just trying to make sense of all of this in the meantime.

Thank you for your help and time.

11 Responses
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Avatar universal
In general, lymph nodes measuring greater than 1 cm in short axis are considered indeterminate/suspicious.

In general, lymph nodes without fatty hilum are considered indeterminate/suspicious.
Helpful - 0
Avatar universal
Hi Ken. Thank you. I was grossly worried about the node but everything you said made me feel so much at ease I decided to put it out of my head until my appointment. I will be sure to update you tomorrow and bring the info you provided. They may suggest another ultrasound as you stated the limited reading. Maybe they’ll do a fine needle aspiration while I’m there. I’m glad the appointment and finally close and grateful for your help.
Talk soon,
Courtney
Helpful - 0
1081992 tn?1389903637
COMMUNITY LEADER
If it eventually ends up that a resection is done, then they will look for cancer and if none is found that will usually be the end of it. But what you should want instead is for the pathologist to look for the cause of the node enlargement. Granulomas, fibrosis, active infection, whatever. Knowing that will be useful to you over you future years.

Good luck tomorrow with your talk with the surgeon.
Helpful - 0
1081992 tn?1389903637
COMMUNITY LEADER
From your latest post, I now think the odds of not-cancer are even higher.

"On a most likely unrelated but interesting note..."
I think it is related. Immune system oddities do not usually come alone. Add in the Raynaud's, too.


Hopefully, that particular surgeon has experience with removing many nodes that turned out to be not-cancer.

The gyno might be great but she likely has no experience in this. It's not her field.

If it was me, I'd want a proper reading of the sono as the next step. Is there a fatty hilum or not? Is other architecture seen? And why not have a color Doppler to look for the pattern of blood flow.

Having those nodes removed is not a trivial thing. They serve a purpose.



Helpful - 0
1081992 tn?1389903637
COMMUNITY LEADER
"cat scratch fever"
is known for enlarging nodes remote from the scratch (not right at the spot) and causing fibrosis (scar tissue) inside which does not just go away when the infection is over


"Vitamin D was low at 35."
vit D is anti-inflammatory, so that's a negative factor gere

"CRP test from 8-18-18 at a value of 8.8"
you don't want to walk around that high for a long period. Over 3 is considered a high risk for heart disease... depending.

"My uncle had hodgkins in his 20s and then non hodgkins later in life"
the Tx for hodgkins if known to  cause non-hodgkins years later


"The nurse just called and said the doctor's recommendation is to have both the nodes removed"
Well, you'll have to decide, unless the surgeon refuses.
Helpful - 0
Avatar universal
My new kitten did scratch my leg on that side a few months ago. When i asked if this was possibly a result of cat scratch fever she said the doxycycline would have taken care of that. I did receive my STD panel results this morning and everything came back as "not detected." CBC results were all within normal range. Vitamin D was low at 35. I do not believe i have had a LDH. I just looked through the last two months of results. There is a slightly positive CRP test from 8-18-18 at a value of 8.8    All test have come back negative besides the ANA and CRP. I was even tested for Chikugunya the mosquito born illness. All negative.

I am 33, female, white
My uncle had hodgkins in his 20s and then non hodgkins later in life which he passes from. (i may have the order wrong). But from what i read i do not believe it runs in families.

The nurse just called and said the doctor's recommendation is to have both the nodes removed but to follow up with the surgeon. My appointment is not until next Wednesday. Its not that far away but seems so far. My understanding is that it is just a consultation. I leave for Disney 2 days after the appointment and we will be there for 10 days. It feels like i may have to wait a very long time for answers.

I am not flexible but i do blush easily but that's typically when attention is on me or if i am upset. I am not sure if that is the same as flushing.

I think i may call the surgeons office and see if i can get in there sooner.

...On a most likely unrelated but interesting note, this has happened twice to me, once last year and once when i was a teenager. I woke up to find a strange uncomfortable feeling in my neck. I felt a large mass and when i went to the mirror i saw an (almost) baseball sized growth off my neck. I mean this thing was huge. Within 20 minutes it was half the size and by the time my doctors office opened at 9am it was almost completely gone. When i called the doctor that morning he simply said sometimes stuff can pool up and get trapped in the lymph nodes while we sleep. When we stand up it drains out. I dont know if that true but really a wild scary thing when its happening.
Helpful - 0
1081992 tn?1389903637
COMMUNITY LEADER
Oops, sorry "Channey". With an 'e'.

Had an LDH blood test?
Age? (for Hodgkin's vs non-Hodgkin's)
Anything remarkable on CBC?

"All of my symptoms have gone away except for the high heart rate and occasional mild joint pain and fatigue. "
So the node maybe/probably should have gone down if inflamed... unless there's remaining fibrosis. And people with overactive immune systems probably generate more fibrosis.


Lot's of speculation going on, but that's what we've got for now.
Helpful - 0
1081992 tn?1389903637
COMMUNITY LEADER
Thanks kindly for the good words, Channy.  I appreciate it.

I think with your last post the odds just went from 50/50 to 65% not-cancer.

An option: get a second reading on the same sono. For instance, sharp borders ("margins") mean that cancer has not grown through the enclosing node capsule. That tends against cancer making the node so big. Or maybe that sono was done slapdash?

There was not too long ago here a guy who had a node that was not-cancer yet was ~5cm long. If you can't find that thread, I'll try.

Inflammation can make a node, whether cancer or not-cancer,  get bigger then smaller. It's sort of like not-real growth. Hmmm... if there's a cyst inside, I wonder if that alone can make a node grow just from extra water accumulating there.

Be super aware if it's still growing.

On the node side leg, anything odd going on there? The node can be downstream of and thus affected by anything in that leg. Bug bites. Impact/trauma.

The immune system can do very mysterious things, as you know.  So can Lyme and co-infections. So can cancer.

Are you by chance hyper flexible? Flush a lot? (You might have read the mast cell threads.)

The rheumy seems correct about not being scleroderma. There's something in the back of my mind about misdiagnosis of that...

Helpful - 0
Avatar universal
Hi Ken
I want to start out by saying thank you so much for your thorough response. I read a few posts and your answers and it’s really amazing the way you help everyone.

I treat my obgyn as my primary care. I do have a pcp but my gyno is amazing and more thorough than my pcp.  I even go there for colds.
That being said, I should provide more information. I saw my pcp in July because I was convinced I had lyme. Joint pain, fever, ankle swelling (opposite side from lymph node), heart palpitations, high resting heart rate (sitting I was anywhere from 98-114), skin crawling sensation, fatigue, and brain fog. Sounds like Lyme right? Only one line came back positive. Convinced I had Lyme I talked my pcp in to prescribing Doxycycline. That had zero effect. I saw an infectious disease specialist and a rheumatologist after that. Both doctors said I did not have Lyme. An ANA test that showed 1:1280 positive with a centromere pattern. That is the only ANA with a definitive result. Scleroderma. My rheumatologist said he doesn’t think I have it though since I only have 1 of the 5 markers, Reynauds.

All of my symptoms have gone away except for the high heart rate and occasional mild joint pain and fatigue.

I spoke to my rheumatologist about the lymph node at my last appointment. He said He did not believe it was related to what was going on with me.

When I saw the gyn I asked why we weren’t doing antibiotics first and she said the doxycycline would have taken care of it had it been an infection. She did an STD panel but I have not received the results yet. I suspect they will be normal.

I’m not sure if it appeared suddenly but I noticed it one day. I’m not sure if it had been growing and I didn’t notice or if it was overnight. But last week it went from large to larger suddenly. And the symptoms from what I thought were Lyme have largely gone away weeks ago so I don’t think the jump in size has to do with that.

Yes I agree that the report didn’t say much. I did omit the 2nd lymph node in the report. It only said “1.7 x 0.7cm lymph node is noted corresponding to the palpable node”
Helpful - 0
1081992 tn?1389903637
COMMUNITY LEADER
The gyno might have jumped to conclusions somewhat because of the large size. That's really not their field, I suppose. The size is certainly not good, but it doesn't automatically mean that the worst diagnosis is waiting for you. You have reasons to take an optimistic attitude.
Helpful - 0
1081992 tn?1389903637
COMMUNITY LEADER
Hi, thanks for alerting me with the PM.

Everything at this point has to do with tending this way or that way. The 3 cm is pretty large, but there are some non-cancer conditions that can make a node that large. The most known is probably tuberculosis. There are also inflammatory conditions.

Yes, being oval is good because cancer tends to grow in all directions equally and make a node be rounded. Yours is not only oval in two dimensions but it's also thin, so to speak, at  0.7 cm. So that's doubly good.

Enlarged inguinal nodes makes one think immediately of an STD, just as enlarged neck nodes makes one think of some head infection.

Like you, I would think the doc would have tried an antibiotic - maybe she didn't because the 3 cm long axis made her want the sono right away. It wouldn't have hurt to try anyway. This is not a case to worry about antibiotic resistance, I'd think.

The surgeon might possibly suggest a needle biopsy instead of a surgical (resectional) biopsy. If most of the node is hypoechoic, I'd guess that makes a false negative less likely. It wouldn't miss the hypoechoic section.

Being hypoechoic could be from inflammation. Possibly like a cyst. Or from cancer.

There was no other text in the sono report? Seems very bare bones. I'd have wanted more about internal architecture, though inflammation (besides cancer) can sometimes wipe that out. Also, Doppler sono would have shown if an increased blood supply from angiogenesis was present - though besides cancer, inflammation can sometimes do that too.

Did the big node come up very suddenly? A node can get very large overnight from infection or inflammation. But then it would tend to plateau and not just keep growing -  unless maybe if it's granulomas accumulating.

If you have a personal or family history of overactive immune systems, that tends to say this node could be from that as well.

So that's an overview. Your thinking has been good all around.

It's beneficial to be as knowledgeable as possible before meeting with the surgeon.







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