I think you should get the biopsy.
"Sorry for spamming this page over the last 8 months off and on."
No, not at all.
"Are the posterior nodes truly more threatening?"
I don't know why that is said but I'd guess the following:
- they do not drain any opening (eyes, ears, etc) so are less likely to be infection
- therefor it's just math, less chance of infection means what remains is non-infectious... but then again that analysis is misleading because it doesn't account for odd, non-malignant immune reactions
...and, the posterior nodes might be suspect for metastasis not lymphoma. But metastatic nodes are more likely to be calcified, which would have shown up on US.
(Sorry for the delay, I've been having some rather big problems.)
"So please let me know if you think I should more for my own peace of mind..."
Yes, that is astute of you. I've switched now and am saying to do it for peace of mind. The reason? There can be no end to thrashing about with thoughts of why/how it could be cancer. That's especially noteworthy because you're focusing now almost exclusively on dimensions, though we have discussed that single dimensions are not very specific (unless gigantic, of course). Maybe you're focusing on single dimensions because that's what the scan reports focus on? I can give an opinion on that.
I'll also restate, as I always have, that I think you should have the biopsy in order to find the real, non-cancer cause - which means they have to look for that and not merely rule out cancer. That's even more true if the number of genuinely enlarged nodes is multiplying.
"I should mention something else interesting, typically I will get sick twice a year. Since the nodes popped up over a year ago I haven’t had a single illness. Does that almost point to my immune system still chewing on that old respiratory infection or still ‘activated’ so to speak?"
Yes, that is interesting and it's not the first time I've heard of such a thing. I'd say it's from immune activation, whatever the cause of the activation (a real infection or immune dysfunction). I'd also read recently about some recent research work wherein immune cells are being genetically altered to be always activated, then injected into patients with weak immunity who are undergoing potentially deadly sepsis -- so these concepts are not just pie in the sky. Also, I recall something about people with allergies having less chance of getting cancer.
"I’ve read multiple places respiratory infections do affect the posterior nodes though?"
I don't think you've mentioned any chest infection until very recently. Correct?
If there is an underlying chest condition that is driving immune activation, then that's possibly an avenue to explore: quell that chest condition and see if the nodes subside.
(1) I would be surprised if this is not all related.
(2) What did the sputum culture say? Bacteria found?
"could a bad pharyngitis and chest infection also swell nodes along the jugular set and under the chin too?"
Your CT ruled out TB and sarcoidosis, but nevertheless consider that they occur mainly in chest but can also cause neck nodes to react. So also can an arm/hand scratch in Cat Scratch Fever (Bartonella) cause neck nodes to react. Therefor, if those conditions (which you don't have) can do it, then why can't your own chest infection do it? See the parallels? That means we are not always bound by lymph drainage patterns.
Sarcoidosis, btw, is some mystery immune dysfunction with unknown etiology.
"Also I will be praying whatever problems you are facing clear out."
Well, thank you, Spartan. I sincerely appreciate you saying that.
"I apologize I bombard you with questions"
Nah, we're practically buddies now :) No need whatsoever to apologize.
"...any frustration you’ve felt in my words I hope you understand are directed at the nodes themselves"
"...and you’ve been nothing but helpful which I’m very thankful for"
Once again, I sincerely appreciate you saying that. You're a good man. Tell you what though: make sure that when this finally gets solved, you'll let me know and not just disappear. Deal? Lots of people/patients just disappear.
"2.6 by .9 cm! ...Are you concerned about that one?"
Nope, because a reactive node grows that way: long and thin.
"....still they only call it prominent not enlarged. That seems wrong doesn’t it?"
I'm with you on that one. 'prominent' seems nebulous. I found these 2:
Radiology Report Best Practices 2016
'Additional tips to creating a high-quality report included:
Size and Measurement... there should be a consistent expression of size such as “trace, small, moderate, large, extremely large,”... stay away from words like “tiny, prominent, chunky, or inconspicuous.'
The Radiology Report 2016
'Perhaps the most mysterious word in radiologist’s lexicon is “prominent” such as “pulmonary arteries are somewhat prominent.” Not even radiologists know what “prominent” really means.'
"I just wish I knew which node the best."
The surgeon won't care what a patient thinks on that. It's about:
- the most suspicious
- but being not risky, e.g. being accessible, near skin and not near nerves, etc
"But if it’s reactive wouldn’t it have gone down after a year?"
I've been mentioning 'fibrosis' since way back, which is akin to scar tissue. It could take forever to go down, but is benign and inert. There might also be some active inflammation at the same time.
"The hematology report does say that ‘his risk for an indolent lymphoma is very low given the stability in nodal size’ do you agree with that assessment even with the large size?"
Absolutely. Very low.
"...my one sensitive tooth (no cavity but dentist said it is ground down which is why it’s sensitive) is on the right side so maybe correlation?"
Pain biochemicals like Substance P and Bradykinin can probably create an inflammatory reaction downstream, I would think.
"Also the FNA report only lists ‘benign lymphocites’ Is that normal?"
Yes, that's very good. It would be interesting to see what tests they did for that. Like Flow Cytometry to see what cell surface proteins are there (normal everyday ones versus cancer ones), plus possibly gene testing like FISH to look for cancer mutations, and/or looking for clonality.
Did you tell me you had an FNA? I don't recall that because I would have asked for detailed results.
"I really want to push for biopsy now, I just wish I knew which node the best. The doctor who offered it unfortunately moved cross country"
Sorry to say then that it might be too late. I was surprised that they were willing in the first place. Insurance might have very well declined nevertheless. It's even more unlikely now with a benign FNA. But then again, you never know until you try. I'd call that doc and ask them to intervene, if nothing else works.
Remind me to look up exosomes for lymphoma, if they exist yet. Or you can look.
Well then, I'll be rooting for you - in that they'll approve the resection.
I would guess that they cannot take the deep node using only local anesthetic, as they might with a superficial node.
-cytology refers to looking at individual cells, or at a group of cells as individuals, being done via using a microscope and an FNA sample smeared on a slide
-immunocytochemistry is the same, except that it involves adding fluourescing antibodies that tag specific proteins in the cell
-flow cytometry is the same as immunocytochemistry, except a stream of cells is passed in a jet of liquid past a sort of detector
-immunohistochemistry is like immunocytochemistry, except the sample includes surrounding tissue and not just cells. So it should make sense that using a bigger core needle would be more suited than FNA for that.
Like so: "With these data, we could conclude that IHC was more effective following CNB than following FNA." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6453787/ 2019