Do i have signs of lymphoma?

[Alishacori]

I had Lyme disease in 2012 since then I’ve had chronic swollen lymph nodes in my neck. They usually grow and shrink but 2 of them never get smaller than 1.5 cm. I’ve had an ENT do a FNA biopsy which didn’t show anything and multiple ultrasounds. I have lost my fatty hilum on 2 of the nodes and they are oval shaped and very mobile. Could it possibly be lymphoma after all of these years? My ent is leaning more towards some type of autoimmune disease. I have an enlarged thyroid as well with nodules. I’m scared to go under for a biopsy because I have heart problems. I don’t want to risk my life for a biopsy if it’s probably not lymphoma. I’ve had these swollen lymph nodes for 6 years and they range from 1.5 cm to 4 cm depending on if I’ have some type of infection going on. I’m only 25 and I’m scared that I have cancer and it’s spread. I heard slow growing lymphoma can take 10-15 years to spread. Should I just go ahead with the surgery and risk my life or not worry about it? The lymph nodes are only tender when I’m sick, otherwise I don’t feel them at all unless I put my fingers on it and move it around.

[Ken_PA]

It's good that you posted all of the reports. The one from 2013 is that one that mentioned the missing hila. That's why the radiologist said that although the nodes are probably benign, the possibility still exists about cancer.

The crucial thing is that none of the ultrasounds after 2013 mention missing hila. So the hila were not destroyed by any cancer after all. That's very good news for you.

Nothing else there from the US's or from the biopsy indicate cancer. More good news.


But you do have something unusual going on with your immune system.

[Alishacori]

I need to see a rheomotologist, I’m sure I have some type of autoimmune disease. Just don’t know what yet. My last ultrasound the radiologist came in and said my lymph nodes look completely benign, but who knows cancer can be sneaky.

[Ken_PA]

and of course possible granulomas inside the nodes from the tick bite

[Alishacori]

Thank you for responding. I will copy and paste all of my previous ultrasounds and FNA biopsy. Thanks for taking your time and reading my story. I get worried sick all of the time about this. My mom also had a lymph node right next to her thyroid that was there for years and had it completely removed, hers was benign. I also have been positive for EBV in the past.

[Alishacori]

My last US in October after an infection:



INDICATION:  Lymphadenopathy.

COMPARISON:  11/17/2017.

TECHNIQUE:  Grayscale and color duplex sonography of the neck performed.

FINDINGS:

Level II on the right shows 3.7 x 0.7 x 1.1 cm morphologically normal-appearing lymph node. This corresponds to the palpable area.

Level II on the right also shows 1.6 x 0.4 x 0.8 cm morphologically normal-appearing lymph node.

Level II on the left shows 2.9 x 0.7 x 1.3 cm morphologically normal-appearing lymph node. This is also palpable.  There is also a level II 1.1 x 0.3 x 0.7 cm normal-appearing lymph node.

No other lymph nodes identified.

IMPRESSION:
Normal lymph nodes as described above.

[Alishacori]

2017 ultrasound:
CEDURE REASON:
RESULT:  INDICATION: Thyroid nodule(s), interval follow-up. Lymphadenopathy.
COMPARISON: Thyroid ultrasound 4/4/2016
TECHNIQUE: Grayscale and color duplex sonography was performed of the thyroid gland and cervical nodes.
FINDINGS:
THYROID:
Thyroid echotexture is: homogeneous.
Size:
Right lobe: 4.5 x 1.6 x 1.9 cm, Volume:  7.2 ml.
Left lobe:  5 x 1.6 x 1.7 cm, Volume: 7.1 ml.
Isthmus: 0.4 cm.
Gland vascularity is within normal limits.
Thyroid nodules: Subcentimeter nodules are present without suspicious features. As per TI-RADS, lesions less than 1cm that are not TI-RADS 5 (highly suspicious) are not detailed in this report as no surveillance or sampling is recommended. Of note, the previously noted subcentimeter thyroid nodules, which are most likely colloid cysts, without interval change.
CERVICAL NODES:
Superior spinal accessory/jugular region (Level II):  On the right there is a 1.5 x 1.3 x 0.5 cm node.
Mid jugular region (Level III):  No lymph nodes or soft tissue masses are identified.
Inferior jugular region (Level  IV): No lymph nodes or soft tissue masses are identified.
Central compartment medial to carotids (Level  VI): No lymph nodes or soft tissue masses are identified.
Central superior mediastinum (Level  VII): No lymph nodes or soft tissue masses are identified.
IMPRESSION:
1.  Stable subcentimeter thyroid nodules. No nodules present that warrant FNA or ultrasound follow-up per ACR TI-RADS.*
2. No cervical adenopathy or masses are identified.

[Alishacori]

2015 ultrasound:

Technique: Grayscale and color duplex sonography of the neck performed.
Results:
19 x 7 x 13 mm and 12 x 4 x 7 mm right level II lymph nodes.
11 x 3 x 8 mm left level III lymph node.
No additional adenopathy seen.
These presumed lymph nodes are oblong in orientation, relatively avascular, and do not disrupt the fascial planes.
Impression:
Interval decrease in size of the right level II lymph node from 3.0 x 0.6 x 1.3 cm to 1.9 x 0.7 x 1.3 cm.
None of the previously noted left level II lymph nodes are seen today. Today there is a solitary left level III lymph node with a long axis of 1.1 cm.

[Alishacori]

Original 2013 ultrasound:
gh-resolution grayscale and color Doppler imaging was performed, right and left sides of the neck.
There are bilateral level II (suprahyoid, upper jugular chain) mildly enlarged lymph nodes. They are homogeneously hypoechoic. They have lost their normal fatty hila. Two on the right measure 1.2 x 0.3 x 0.5 cm, 3.4 x 0.6 x 1.4 cm, and correlate with the palpable area. The two nodes on the left measure 1.3 x 0.4 x 1.0 cm, 3.7 x 0.7 x 1.7 cm. No calcifications noted. No other mass is detected.
IMPRESSION:
Mild bilateral neck lymphadenopathy. Please see above description. This is likely benign/reactive mild lymphadenopathy. The differential includes a lymphoproliferative disorder and metastatic disease (It is unlikely for metastatic disease to produce smooth homogeneous lymph node involvement, but not unknown). Clinical correlation and followup will be necessary.

[Alishacori]

: FNA of Right Cervical Neck MassCLINICAL
DIAGNOSISRight neck massFINAL PATHOLOGIC DIAGNOSISRight cervical mass, fine needle aspirate:Heterogeneous lymphoid population with no evidence of abnormalityon flow cytometry (see note).Note:     The overall features are suggestive of a reactivelymphoid
hyperplasia.  However, a negative finding on the aspiratedoes not entirely exclude a neoplastic process in a highly suspiciousclinical setting.  Clinical and radiographic correlation
Reported: 1/13/2014MACROSCOPIC DESCRIPTIONReceived are several drops of bloody fluid from four passes of a fineneedle aspiration of a right cervical neck mass performed.Four air-dried smears, two alcohol fixed smears and needle rinses
inHank's solution sent to Mayo for flow cytometry.If applicable, all available clinical lab results for this material(i.e. hematology, chemistry and microbiology) are reviewed forcorrelation with cytologic findings.A copy of the patient's ultrasound
report, which was attached,was reviewed.INTRAOPERATIVE CONSULTATIONImmediate Interpretation:  The specimen appears to be adequate basedon an immediate review of the air-dried smears only.  This review wasperformed via telepathology MICROSCOPIC DESCRIPTIONThe cytologic material prepared from the fine needle aspirate of theright cervical mass shows a heterogeneous lymphoid population composedof abundant small round lymphocytes with occasional medium-sized andlarge lymphocytes
admixed.  There are numerous tingible bodymacrophages and fragments of germinal centers.  There is no evidenceof metastatic carcinoma.  There is no evidence of granuloma.  Thereare no significant numbers of atypical mononuclear cells.A portion of the
aspirate was sent to Mayo Medical Laboratories forflow cytometry.  The cells were examined with a triage panel, whichincluded antibodies to CD3, CD5, CD7, CD10, CD19, CD20, CD23, CD45,7AAD and surface immunoglobulin kappa and lambda light chains.Analysis
showed no abnormal B-cells, no abnormal T-cells and noincreased blasts.  {{END OF REPORT}}
Final Diagnosis
Right cervical mass, fine needle aspirate:     Heterogeneous lymphoid population with no evidence of abnormality on flow cytometry (see note).     Note:     The overall features are suggestive of a reactive lymphoid hyperplasia.  However, a negative
finding on the aspirate does not entirely exclude a neoplastic process in a highly suspicious clinical setting.  Clinical and radiographic correlation is required.

[Ken_PA]

Hi, from your detailed and knowledgeable descriptions, I would think that what you have is chronic inflammation, with occasional acute inflammation, possibly combined with some fibrosis inside the nodes.

Inflammation in a node can efface the hilum, the same as lymphoma can do. Being oval is a good sign, as you know, because cancer tends to eventually grow out in all directions and so then becomes rounded.  

"They usually grow and shrink"
Lymphoma can wax and wane a little but would over time get bigger and bigger. If yours instead shrink considerably, then think of this: if your body can sometimes kill off a cancer and make the node smaller, why would it stop? Also, compare to how an anti-cancer vaccine trains the immune cells to kill a cancer -- the body wipes out the cancer completely and rather quickly. So the behavior you describe seems much more like inflammation lessening, than cancer cells being sometimes partly killed off.

"they range from 1.5 cm to 4 cm"
Nodes with TB can also get quite large, but just as yours they are oval.

"The lymph nodes are only tender when I’m sick"
Inflammatory cells reacting to, say, a virus cold will produce powerful chemicals that travel and that rouse up other inflammatory cells in a chain reaction.

"an enlarged thyroid as well with nodules"
another possible source starting a chain reaction, though more constant

Plus Lyme and co-infections can do strange things over a long time.

Your self awareness and analysis are terrific - especially regarding how the nodes change depending on if you are sick or not. I don't see any reason for a surgical biopsy at this time. Maybe another FNA eventually.

Can you post the latest sono report? Any cystic or necrotic foci? What about vascularity on Doppler?