Aa
Lymphoma or false alarm?
My 48 year old has been having submental , submandibular and posterior cervical lymph node swelling in right and left lobes
please find enclosed picture of results.
A- report of 10/ September 16
B- report 27 September 16
What are the chances this can be Cancer?
Kindly help. Thanks
please find enclosed picture of results.
A- report of 10/ September 16
B- report 27 September 16
What are the chances this can be Cancer?
Kindly help. Thanks
COMMUNITY LEADER
...test
2 Comments
Thanks for your input. If it confirms Granuloma by biopsy test, what is the way out?
Well, that could explain why the nodes won't go down (if they don't). It might give a clue as to the infecting organism. It might tell why the augmentin didn't have any effect. It might affect what treatment is chosen, I don't know. This is somewhat out of my realm.
But if the pathogen doesn't usually result in granuloma, then that's a clue to a particular deficiency in her immune system. It would also be something to remember for any future infections in urinary tract or even lungs. E faecalis gets in a lot of places, and even causes dental plaque and tartar.
Your doc might think the previous paragraph is getting too involved.
Sorry, got to go for now.
But if the pathogen doesn't usually result in granuloma, then that's a clue to a particular deficiency in her immune system. It would also be something to remember for any future infections in urinary tract or even lungs. E faecalis gets in a lot of places, and even causes dental plaque and tartar.
Your doc might think the previous paragraph is getting too involved.
Sorry, got to go for now.
COMMUNITY LEADER
A needle biopsy? I don't know if they'd do it, but if they thereby verify granulomas, that might be very helpful to you in deciding how to help her in all the coming years.
Like so: her system detects the bacteria, but can't kill it. So are her neutrophils low in *activity*? (I presume there aren't any low *numbers* on CBCs.) Meanwhile, her monocytes and descendants seem to be operating okay in forming granulomas to wall off the bacteria.
Analogy: there can be a whole lot of troops (bacteria destroying neutrophils), but they mostly just lay around. So the reserves (monocytes) come in.
Thus we can move beyond merely saying "weak immunity" and concentrate on identifying which part is the weak link. Then you might discover a way to boost that weak link. It's maybe possible.
Like so: her system detects the bacteria, but can't kill it. So are her neutrophils low in *activity*? (I presume there aren't any low *numbers* on CBCs.) Meanwhile, her monocytes and descendants seem to be operating okay in forming granulomas to wall off the bacteria.
Analogy: there can be a whole lot of troops (bacteria destroying neutrophils), but they mostly just lay around. So the reserves (monocytes) come in.
Thus we can move beyond merely saying "weak immunity" and concentrate on identifying which part is the weak link. Then you might discover a way to boost that weak link. It's maybe possible.
Sorry the chart I had uploaded got removed somehow by the system. The results are as follows-
The sonography report was as follows-
Date 10 September 2016
Lymph node level Right Lobe Left Lobe
Submental --- 0.8 x 0.7 cms
0.8 x 0.7 cms
1.1 x 0.6 cms
Submandibular 1.2 x 0.6 cms 1.8 x 0.6 cms
Upper Jugular 1.7 x 0.7 cms 2.6 x 0.7 cms
Post cervical 1.9 x 0.3 cms 2.2 x 0.4 cms
1.5 x 0.4 cms 2.1 x 0.4 cms
1.9 x 0.4 cms
1.5 x 0.5 cms
1.9 x 0.6 cms
On 27th September after an antibiotic course of 10 days with Augmentin , we got a new sonography done and the lymph nodes had shrunk a little. Results as follows-
Date 27 September 2016
Lymph node level Right Lobe Left Lobe
Submental --- 0.8 x 0.5 cms
0.8 x 0.5 cms
Submandibular 0.9x 0.3 cms -
Upper Jugular 0.9 x 05 cms 2.6 x 0.6 cms
Post cervical 1.5 x 0.4 cms 1.6 x 0.3 cms
0.9 x 0.3 cms 1.9 x 0.4 cms
2.0 x 0.5 cms 1.6 x 0.4 cms
The sonography report was as follows-
Date 10 September 2016
Lymph node level Right Lobe Left Lobe
Submental --- 0.8 x 0.7 cms
0.8 x 0.7 cms
1.1 x 0.6 cms
Submandibular 1.2 x 0.6 cms 1.8 x 0.6 cms
Upper Jugular 1.7 x 0.7 cms 2.6 x 0.7 cms
Post cervical 1.9 x 0.3 cms 2.2 x 0.4 cms
1.5 x 0.4 cms 2.1 x 0.4 cms
1.9 x 0.4 cms
1.5 x 0.5 cms
1.9 x 0.6 cms
On 27th September after an antibiotic course of 10 days with Augmentin , we got a new sonography done and the lymph nodes had shrunk a little. Results as follows-
Date 27 September 2016
Lymph node level Right Lobe Left Lobe
Submental --- 0.8 x 0.5 cms
0.8 x 0.5 cms
Submandibular 0.9x 0.3 cms -
Upper Jugular 0.9 x 05 cms 2.6 x 0.6 cms
Post cervical 1.5 x 0.4 cms 1.6 x 0.3 cms
0.9 x 0.3 cms 1.9 x 0.4 cms
2.0 x 0.5 cms 1.6 x 0.4 cms
1 Comments
I found the critical info in your post on the other forum. This all happened suddenly and the nodes increased all over at once. That is not how lymphoma would behave, nor would such a super aggressive cancer usually just stop growing on its own. Your wife had the dental procedure, which tells us that infection is even more likely as the cause. So at this point you can relax somewhat, as cancer is not likely.
We also look at the alarming length of the biggest node: 2.6 x 0.7 cm. Cancer can do that, but so can a granulomatous disease. When the immune system cannot wipe out an infection it will wall off the invaders such as bacteria. Nodes can be packed full of such granulomas.
Granolumas can also lead to fibrosis, which is scarring/collagen that can take a long time to go down.
Augmentin is the usual abx for dental infections.
If you are very concerned you can ask for a sonogram of the largest node to see what it looks like inside - not just to measure its dimensions. But that doesn't seem necessary.
Good luck to you and your wife.
We also look at the alarming length of the biggest node: 2.6 x 0.7 cm. Cancer can do that, but so can a granulomatous disease. When the immune system cannot wipe out an infection it will wall off the invaders such as bacteria. Nodes can be packed full of such granulomas.
Granolumas can also lead to fibrosis, which is scarring/collagen that can take a long time to go down.
Augmentin is the usual abx for dental infections.
If you are very concerned you can ask for a sonogram of the largest node to see what it looks like inside - not just to measure its dimensions. But that doesn't seem necessary.
Good luck to you and your wife.
COMMUNITY LEADER
I'd start slowly, with some fat for better absorption, with a bit of sugar if necessary to handle the bad taste... and keep your fingers crossed that she gets some benefit :)
(btw if you post with any updates, let me know with a PM because I don't check here all the time)
(btw if you post with any updates, let me know with a PM because I don't check here all the time)
Great! That's very reliving. I'll immediately start her on neem and redo the test after 1-2 months. Thanks for all the help bro!
1 Comments
relieving*
Hi Ken
The doc has asked us to wait and watch and doesn't suggest biopsy as of now. he has ruled out malignancy/lymphoma. Do you concur?
I personally suspect it has something to do with dental procedure given the timing. If it is granulomatous disease of some sort, what could be the prognosis and corrective action?
The reason for Doppler sono suggestion by the doc was to check for vascularity of the nodes. Hope the results don't show anything alarming.
Thanks for all the help.:)
The doc has asked us to wait and watch and doesn't suggest biopsy as of now. he has ruled out malignancy/lymphoma. Do you concur?
I personally suspect it has something to do with dental procedure given the timing. If it is granulomatous disease of some sort, what could be the prognosis and corrective action?
The reason for Doppler sono suggestion by the doc was to check for vascularity of the nodes. Hope the results don't show anything alarming.
Thanks for all the help.:)
1 Comments
No malignancy, because cancer wouldn't make some nodes still have hilum and because vascularity is central (where it belongs), not out in the node where cancer cells actually cause new blood vessels to grow and feed them.
AFAIK, granulomas won't go away by themselves, except maybe over a very long time. I'd still try the neem etc as previously suggested to see if that might help. You should check all the current sizes and see if any are growing still. Note that mostly the largest ones have the hilum missing.
"The reason for Doppler sono suggestion by the doc was to check for vascularity of the nodes." Yes, but they also checked the neck blood vessels - for which they discovered only a small amount of atherosclerosis, probably less than average and maybe much less.
AFAIK, granulomas won't go away by themselves, except maybe over a very long time. I'd still try the neem etc as previously suggested to see if that might help. You should check all the current sizes and see if any are growing still. Note that mostly the largest ones have the hilum missing.
"The reason for Doppler sono suggestion by the doc was to check for vascularity of the nodes." Yes, but they also checked the neck blood vessels - for which they discovered only a small amount of atherosclerosis, probably less than average and maybe much less.
COMMUNITY LEADER
So now there are various approaches:
- merely watch and wait some more, which is probably what was recommended
- investigate further with resectional biopsy to stain slices and see what microbes might be inside a node. You'd expect that to be whatever was let loose from the dental surgery. Whatever immune cells have accumulated might also possibly be a clue, such as eosinophils versus neutrophils.
- find out what diseases fit the profile: granulomatous disease that sometimes but not always causes destruction of hilum and possible necrosis. If a microbe, it originates in mouth but apparently doesn't affect lungs or esophagus.
I don't know the answer to that last one, but would start there.
This says that many are unexplained:
http://www.nature.com/modpathol/journal/v25/n1s/full/modpathol2011155a.html
...which leads back to watch and wait, as long as any very dangerous possibilities are ruled out.
Wegener's is necrotizing but doesn't seem to fit here as it usually doesn't affect nodes. Why were the arteries Doppler sono'ed? Was that to check for vasculitis? Or merely to check for atherosclerosis as long as a sono in the neck area was being done (two birds with one stone, if you know the phrase)?
Anyway, you should be relived because her sono results are not bad.
- merely watch and wait some more, which is probably what was recommended
- investigate further with resectional biopsy to stain slices and see what microbes might be inside a node. You'd expect that to be whatever was let loose from the dental surgery. Whatever immune cells have accumulated might also possibly be a clue, such as eosinophils versus neutrophils.
- find out what diseases fit the profile: granulomatous disease that sometimes but not always causes destruction of hilum and possible necrosis. If a microbe, it originates in mouth but apparently doesn't affect lungs or esophagus.
I don't know the answer to that last one, but would start there.
This says that many are unexplained:
http://www.nature.com/modpathol/journal/v25/n1s/full/modpathol2011155a.html
...which leads back to watch and wait, as long as any very dangerous possibilities are ruled out.
Wegener's is necrotizing but doesn't seem to fit here as it usually doesn't affect nodes. Why were the arteries Doppler sono'ed? Was that to check for vasculitis? Or merely to check for atherosclerosis as long as a sono in the neck area was being done (two birds with one stone, if you know the phrase)?
Anyway, you should be relived because her sono results are not bad.
Hi , Got the color doppler test done. The nodes are still the same. I want to upload test findings. Any idea how can I upload 3 pictures?
2 Comments
Sorry for the late reply. Please see the pics uploaded.
Saw the doc today. Suggested doppler ultrasound after a month. Asked to wait and watch.
1 Comments
Well, that's the doc saying that they don't care much about the cause as long as the condition is not a threat for now.
Btw, I'd thought that would be their approach and that's why I brought up the neem earlier. The neem is something she can safely try - though I'd phone the doc anyway and ask if it's okay to do. (Note that it's said to have an awful taste.) I don't guess that she'd want to be walking around with bumps for months or years.
Sorry for the delay, I was extremely distracted by a bad occurrence irl.
Btw, I'd thought that would be their approach and that's why I brought up the neem earlier. The neem is something she can safely try - though I'd phone the doc anyway and ask if it's okay to do. (Note that it's said to have an awful taste.) I don't guess that she'd want to be walking around with bumps for months or years.
Sorry for the delay, I was extremely distracted by a bad occurrence irl.
Thanks so much. We will take it up with the doc on Monday. Great help much appreciated.
Thanks so much. As a non-medical person, it is certainly a lot to absorb. :) Anyway I will bounce the idea of g'ranuloma possibility' with the local doc and see if they want to go fro biopsy.
The Bone Marrow transplant was in 1994 and post that she's had no major infection except cold/cough/fever form time to time.
Sorry for the delay in reply but we are in different time zones. .
The Bone Marrow transplant was in 1994 and post that she's had no major infection except cold/cough/fever form time to time.
Sorry for the delay in reply but we are in different time zones. .
1 Comments
I'd point out to the doc that a length of 2.6cm seems too big for a normally reactive node, and that 2.2 x 0.4cm gives a ratio of 5.5 that seems way too big for a normally reactive node.
The only non-cancer cause I know for that is granuloma in the node.
The only non-cancer cause I know for that is granuloma in the node.
I am sorry but here they don't give test range for most counts . All blood counts are normal they say. The whole report was as follows-
Hemoglobin: 11.1 g/dl
Hematrocit 34.6%
RBC count: 3.87
WBC 7.9 (normal range in India as I know 4 -10)
platelet 256
MCv 89 (range 75-95)
MCH 29 (range 27-32 pg)
mCHC 32 (range 30-25 g/dl)
ESR 26 (range 0 2-10) but they say even 26 is OK
Differential count of WBC
Polymorphs: 44%
Eosinophils 10%
Basophils 1%
Lymphocytes 42%
monocytes 3%
Do you suggest any specific blood test/any other test?
Hemoglobin: 11.1 g/dl
Hematrocit 34.6%
RBC count: 3.87
WBC 7.9 (normal range in India as I know 4 -10)
platelet 256
MCv 89 (range 75-95)
MCH 29 (range 27-32 pg)
mCHC 32 (range 30-25 g/dl)
ESR 26 (range 0 2-10) but they say even 26 is OK
Differential count of WBC
Polymorphs: 44%
Eosinophils 10%
Basophils 1%
Lymphocytes 42%
monocytes 3%
Do you suggest any specific blood test/any other test?
2 Comments
Sorry but
do you suspect lymphoma chances? Why biopsy otherwise?
do you suspect lymphoma chances? Why biopsy otherwise?
"All blood counts are normal they say."
Okay, that'll have to do. So there is nothing overtly remarkable in her CBCs.
"...do you suspect lymphoma chances?"
Nope. There is no reason to suspect lymphoma. They do not suspect that, either - as they must have said so to you.
There are two things at play here: the current problem, which is apparently self-limiting. Then the long term problem - which has to do with whether there are granulomas in her nodes which relates to her future with any new. future infections.
The biopsy would be intended, in my mind, to verify granuloma - as relates to #2 above..
Nope, no lymphoma worries are reasonable.
This is a lot to absorb, of course, even though you have a lot of capability.
Okay, that'll have to do. So there is nothing overtly remarkable in her CBCs.
"...do you suspect lymphoma chances?"
Nope. There is no reason to suspect lymphoma. They do not suspect that, either - as they must have said so to you.
There are two things at play here: the current problem, which is apparently self-limiting. Then the long term problem - which has to do with whether there are granulomas in her nodes which relates to her future with any new. future infections.
The biopsy would be intended, in my mind, to verify granuloma - as relates to #2 above..
Nope, no lymphoma worries are reasonable.
This is a lot to absorb, of course, even though you have a lot of capability.
Hi , We got her blood works done today and the results are-
WBC count: 7.3
Platelet 225.0 x 10'/l
ESR 26 mm/hr
Differential count of WBC
Polymorphs: 44%
Eosinophils 10%
Basophils 1%
Lymphocytes 42%
monocytes 3%
The docs has suggested we wait and watch and get another sonography done after 2-3 weeks/
WBC count: 7.3
Platelet 225.0 x 10'/l
ESR 26 mm/hr
Differential count of WBC
Polymorphs: 44%
Eosinophils 10%
Basophils 1%
Lymphocytes 42%
monocytes 3%
The docs has suggested we wait and watch and get another sonography done after 2-3 weeks/
2 Comments
*the doc
Can you post the test ranges?
Also: you can see that they are interested in treating only this episode. Since she is not getting worse, there is no rush to do anything.
That's usual. But this episode can instead been seen as an opportunity to help her long range to overcome her immune susceptibilities. If the nodes do not go down much, then I'd press for the biopsy.
My off the cuff guess is that the nodes will not go down much.
Also: you can see that they are interested in treating only this episode. Since she is not getting worse, there is no rush to do anything.
That's usual. But this episode can instead been seen as an opportunity to help her long range to overcome her immune susceptibilities. If the nodes do not go down much, then I'd press for the biopsy.
My off the cuff guess is that the nodes will not go down much.
Hi , I would be very interested in knowing 'neem' study. Please post when you get time.
Do you suggest biopsy as of now or wait till we find the bug torturing her? Yeah it's a shame she has to pass through so much in life. Karma - as we Hindus would call it.
Do you suggest biopsy as of now or wait till we find the bug torturing her? Yeah it's a shame she has to pass through so much in life. Karma - as we Hindus would call it.
2 Comments
Here you go: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3895719/
"Comparison of the antibacterial efficiency of neem leaf extracts, grape seed extracts and 3% sodium hypochlorite against E. feacalis – An in vitro study" 2013
Note that the use is topical. I don't know if a person can absorb enough to be effective systemically. I think that the GSE also studied is absorbed better with some fat. Turmeric with black pepper (and fat). Maybe neem is similar.
Those are all homegrown for you. Maybe that's some Karma :)
"Comparison of the antibacterial efficiency of neem leaf extracts, grape seed extracts and 3% sodium hypochlorite against E. feacalis – An in vitro study" 2013
Note that the use is topical. I don't know if a person can absorb enough to be effective systemically. I think that the GSE also studied is absorbed better with some fat. Turmeric with black pepper (and fat). Maybe neem is similar.
Those are all homegrown for you. Maybe that's some Karma :)
:) noted sir
COMMUNITY LEADER
Btw, I've seen a study on using neem against oral enterococcus bacteria. I'll find it if you're interested. The bacteria involved are probably just the ordinary suspects, and no need to culture. But with her transplant, the ordinary becomes extra dangerous. It's a shame that she has to face these problems after having gone through so much already.
There's something about this immune-wise that I can't quite place. If the thought crystallizes tomorrow, I'll post it.
There's something about this immune-wise that I can't quite place. If the thought crystallizes tomorrow, I'll post it.
Thanks again for your elaborate reply. She underwent dental implant procedure 8-10 days before occurrence of swollen Lymph nodes.
She has a history of CML (Chronic Myleloid Leukemia) which was cured 22 years back with allogenic bone marrow transplant and has been BCR-ABL negative ever since. However she is a little immuno-compromised and has always been more susceptible to infections than others.
What is the way to find out what pathogens/bacteria could be causing this? Do we still go for further sonography to check how the nodes look from inside? What exactly is this called in medial terms.
Truly appreciate all your help and thank you for your time and assistance.
She has a history of CML (Chronic Myleloid Leukemia) which was cured 22 years back with allogenic bone marrow transplant and has been BCR-ABL negative ever since. However she is a little immuno-compromised and has always been more susceptible to infections than others.
What is the way to find out what pathogens/bacteria could be causing this? Do we still go for further sonography to check how the nodes look from inside? What exactly is this called in medial terms.
Truly appreciate all your help and thank you for your time and assistance.
2 Comments
BTW she's had no fever ever in last 1 month.
I'm glad to be of help. I'm just guessing but they might have to pull the implant. It's difficult to get antibiotics down in there. Many people regret having, e.g., root canals - but those are still a minority.
An antibiotic-resistant bacteria is always a possibility.
An occult infection in a jawbone can cause downstream nodes to "react". Think of a net stretched across the mouth of a river, detecting anything that originated upstream. Yet curiously with her, *both* sides are reacting to an implant on one side, which doesn't seem usual.
"What is the way to find out what pathogens/bacteria could be causing this?"
Maybe a needle biopsy, then try to culture the sample. More commonly, maybe trying different antibiotics or combinations. I wouldn't want an excisional biopsy at this point because nodes have a useful job to do. But still, an excisional biopsy is the only way to know what's going in inside for sure.
"What exactly is this called in medial terms."
A cancer can "efface the node's internal architecture" because the cancerous cells replace the normal cells. A tomato has a structure inside, whereas a potato does not. In a scan, the presence of the feature called the "fatty hilum" almost always means no-cancer.
A node that is seen to be "reactive" on a scan means the normal architecture is still there. It grows bigger because the immune cells that fight infection have greatly multiplied. It's like a peacetime army base filling up with troops during a threat.
Fibrosis is very roughly like the base filing with rubble when the battle takes place right inside the node.
Also, the enclosing capsule/membrane will still be there in a reactive node, but a cancer grows right through (except maybe not in Hodgkins vs non-Hodgkins).
Some bacterial infections don't produce fever. Some non-bacterial infections (e.g., flu) do.
An antibiotic-resistant bacteria is always a possibility.
An occult infection in a jawbone can cause downstream nodes to "react". Think of a net stretched across the mouth of a river, detecting anything that originated upstream. Yet curiously with her, *both* sides are reacting to an implant on one side, which doesn't seem usual.
"What is the way to find out what pathogens/bacteria could be causing this?"
Maybe a needle biopsy, then try to culture the sample. More commonly, maybe trying different antibiotics or combinations. I wouldn't want an excisional biopsy at this point because nodes have a useful job to do. But still, an excisional biopsy is the only way to know what's going in inside for sure.
"What exactly is this called in medial terms."
A cancer can "efface the node's internal architecture" because the cancerous cells replace the normal cells. A tomato has a structure inside, whereas a potato does not. In a scan, the presence of the feature called the "fatty hilum" almost always means no-cancer.
A node that is seen to be "reactive" on a scan means the normal architecture is still there. It grows bigger because the immune cells that fight infection have greatly multiplied. It's like a peacetime army base filling up with troops during a threat.
Fibrosis is very roughly like the base filing with rubble when the battle takes place right inside the node.
Also, the enclosing capsule/membrane will still be there in a reactive node, but a cancer grows right through (except maybe not in Hodgkins vs non-Hodgkins).
Some bacterial infections don't produce fever. Some non-bacterial infections (e.g., flu) do.
Thanks a lot indeed! She underwent a sonography of abdomen/pelvis and a chest X-ray today to find out if there are other swollen Lymph nodes. Both turned out to be normal.
She had a slight tingling sensation in the jaw today. Could that be due to infection? Appreciate all your help.
She had a slight tingling sensation in the jaw today. Could that be due to infection? Appreciate all your help.
1 Comments
The chest scan was probably to rule out tuberculosis (a granulomatous disease), though that is very unlikely to have been in the mouth. The other scan would be to look for other enlarged nodes. With those two things ruled out, they can concentrate on what pathogen is involved in the neck - which must be the same one that caused the tooth problem.
The tingling in the jaw? I don't know, maybe a swollen node is pressing on a nerve. Or maybe it's a referred sensation, really caused somewhere else - such as when a person has "referred pain". I don't guess that it's a worry, just a minor side issue.
I'd keep a watch on her temperature, just on the small chance that the infection might spread.
One thing I'd wonder: why her? Why did she have such a significant reaction? Did something bad happen during the oral surgery to spread the bacteria? Or does she (or her family) have any history of immune system problems?
Please let me know what happens.
The tingling in the jaw? I don't know, maybe a swollen node is pressing on a nerve. Or maybe it's a referred sensation, really caused somewhere else - such as when a person has "referred pain". I don't guess that it's a worry, just a minor side issue.
I'd keep a watch on her temperature, just on the small chance that the infection might spread.
One thing I'd wonder: why her? Why did she have such a significant reaction? Did something bad happen during the oral surgery to spread the bacteria? Or does she (or her family) have any history of immune system problems?
Please let me know what happens.
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