Aa
Swollen Submandibular Lymph Nodes
Okay, so I had some ultrasounds and a CT done on my neck about a year ago. The ultrasound showed some abnormal lymph nodes, with the biggest being about 9mm. The CT showed absolutely nothing so my doctor just dropped the case as palpable benign lymph nodes (I made a post about this a little over a year ago). Well now I can feel more lymph nodes (one on the side of my neck, a few more in the submandibular/sub mental region, and one on the opposite lower side of my neck), all about a centimeter size. The original nodes are still there and don't seem to have grown. I have to get another ultrasound done and most likely a FNA. My new doctor did blood work and doesn't seem too concerned and doesn't think it's cancerous based on that, she is just doing the FNA just in case. From what I've read, Lymphoma usually doesn't make an appearance in blood work, even if I've had it for almost two years.
To summarize:
- I'm a 20 year old female, I first found the the nodes when I was 18.
- it has taken about a year for 3 or 4 more nodes to pop up.
- Indolent lymphomas are extremely rare for someone my age so I don't THINK it could be that.
- Is it normal for Hodgkin's to grow this slowly?
- I have impacted wisdom teeth and swollen gums from when I had braces, so maybe that could be causing this?
Unfortunately, I'm a huge hypochondriac, so these tiny little lumps in my neck are causing me all sorts of problems.
To summarize:
- I'm a 20 year old female, I first found the the nodes when I was 18.
- it has taken about a year for 3 or 4 more nodes to pop up.
- Indolent lymphomas are extremely rare for someone my age so I don't THINK it could be that.
- Is it normal for Hodgkin's to grow this slowly?
- I have impacted wisdom teeth and swollen gums from when I had braces, so maybe that could be causing this?
Unfortunately, I'm a huge hypochondriac, so these tiny little lumps in my neck are causing me all sorts of problems.
COMMUNITY LEADER
Another possibility for nodes that seem permanently enlarged and also hard yet mobile would be some granulomatous disease. Yes, I'd very much think that your 'tonsil stones' as you described last year are related.
From "A clinicopathologic series of 22 cases of tonsillar granulomas":
https://www.ncbi.nlm.nih.gov/pubmed/10718441
"a number [of cases] may not develop an identifiable etiology, with the granulomas probably representing an exaggerated immune response to chronic tonsillitis."
You might have something similar to but yet different from Kikuchi disease or Rosai-Dorfman disease. But your nodes don't have necrosis in the center, while they are too small for Rosai-Dorfman. The histiocytes could be in the tonsils and also in the nodes, surrounding and walling off some common infection.
Did you start off in the very beginning with a fever?
As you are learning, you should eventually feel as if your head will explode from too much information. Then you'll know you are proceeding correctly :)
From "A clinicopathologic series of 22 cases of tonsillar granulomas":
https://www.ncbi.nlm.nih.gov/pubmed/10718441
"a number [of cases] may not develop an identifiable etiology, with the granulomas probably representing an exaggerated immune response to chronic tonsillitis."
You might have something similar to but yet different from Kikuchi disease or Rosai-Dorfman disease. But your nodes don't have necrosis in the center, while they are too small for Rosai-Dorfman. The histiocytes could be in the tonsils and also in the nodes, surrounding and walling off some common infection.
Did you start off in the very beginning with a fever?
As you are learning, you should eventually feel as if your head will explode from too much information. Then you'll know you are proceeding correctly :)
I had the TB skin test done when I was around 16 or 17 years old for a nursing class at my high school and it was negative. Of course, I could have had it again. I don't think it was tested for in the recent blood work.
Here is is very first ultrasound report. When they did the follow up there were no significant changes, and then the CT scan showed nothing significant.
"
I went to the doctor in
February due a swollen lymph node in my neck. I told her that I had first noticed it in January and that it has neither increased or decreased in size from what I could tell. She didn't seem TOO concerned about it, but ordered an ultrasound for me anyways. I went to get an ultrasound the next day and these were the results:
Ovoid left submandibular lymph node (level IB) noted, measuring 10 x 5 x 9 mm (transverse, AP and CC dimension respectively). Internal architecture is heterogeneous with lack of normal hilar morphology. Intralesional hypervascularity noted with a
centralized feeding vessel. Adjacent smaller hypoechoic lymph node noted measuring 7 x 5 x 5 mm. This also demonstrates lack of normal hilar morphology. Visualized regional musculature demonstrates a normal sonographic appearance.
IMPRESSION:
Ovoid hypervascular node at the left submandibular region, suspect inflammatory (reactive) lymph node. However given abnormal architecture and hypervascularity, malignant node or other neoplasm remain considerations. Consider followup ultrasound in 2-3
months for revaluation. "
"
I went to the doctor in
February due a swollen lymph node in my neck. I told her that I had first noticed it in January and that it has neither increased or decreased in size from what I could tell. She didn't seem TOO concerned about it, but ordered an ultrasound for me anyways. I went to get an ultrasound the next day and these were the results:
Ovoid left submandibular lymph node (level IB) noted, measuring 10 x 5 x 9 mm (transverse, AP and CC dimension respectively). Internal architecture is heterogeneous with lack of normal hilar morphology. Intralesional hypervascularity noted with a
centralized feeding vessel. Adjacent smaller hypoechoic lymph node noted measuring 7 x 5 x 5 mm. This also demonstrates lack of normal hilar morphology. Visualized regional musculature demonstrates a normal sonographic appearance.
IMPRESSION:
Ovoid hypervascular node at the left submandibular region, suspect inflammatory (reactive) lymph node. However given abnormal architecture and hypervascularity, malignant node or other neoplasm remain considerations. Consider followup ultrasound in 2-3
months for revaluation. "
2 Comments
Hi, the sono report tells most everything you need to know at this point. The presence of the hilum almost always means no-cancer. But the absence of the hilum doesn't necessarily mean cancer. E.g., fierce inflammation can also efface the hilum.
Normally, one would think of hypervascularity as being bad. But in your case, that seems confined to where the hilum would be, so the hypervascularity is probably not from cancer. It's also has on;y that one single blood vessel, which likely means means the node is reactive - as opposed to distributed vessels which are bad.
The size and shape are okay. Your nodes might be staying enlarged because of fibrosis/scarring.
Have you been tested for tuberculosis? There is a resurgence which is likely due to immigration.
Your biopsy will likely show no-cancer. Be aware of false positive CNAs, but still you likely don't have cancer anyway. The next step is that you should want to discover the "why me?" of what is going on - if not an unusual infection then a hyper immune system.
I will dig up a nice, detailed ref for sono in suspected nodes if you like.
Normally, one would think of hypervascularity as being bad. But in your case, that seems confined to where the hilum would be, so the hypervascularity is probably not from cancer. It's also has on;y that one single blood vessel, which likely means means the node is reactive - as opposed to distributed vessels which are bad.
The size and shape are okay. Your nodes might be staying enlarged because of fibrosis/scarring.
Have you been tested for tuberculosis? There is a resurgence which is likely due to immigration.
Your biopsy will likely show no-cancer. Be aware of false positive CNAs, but still you likely don't have cancer anyway. The next step is that you should want to discover the "why me?" of what is going on - if not an unusual infection then a hyper immune system.
I will dig up a nice, detailed ref for sono in suspected nodes if you like.
should read--> false negative CNAs
COMMUNITY LEADER
"I have impacted wisdom teeth and swollen gums from when I had braces, so maybe that could be causing this?"
Yes, that's most likely. However, that doesn't quite explain why there is that odd cascading behavior - and that behavior probably explains ordering the FNA.
Can you post the sono report? There are some key things to look for, to mostly rule out cancer.
"Unfortunately, I'm a huge hypochondriac..."
My own belief is that people who are prone to worry also likely have very reactive immune systems.
Yes, that's most likely. However, that doesn't quite explain why there is that odd cascading behavior - and that behavior probably explains ordering the FNA.
Can you post the sono report? There are some key things to look for, to mostly rule out cancer.
"Unfortunately, I'm a huge hypochondriac..."
My own belief is that people who are prone to worry also likely have very reactive immune systems.
Also to add: The nodes feel hard-ish(?) but are super mobile. And the ultrasound noted some hypervascularity.
Have an Answer?
You are reading content posted in the Leukemia and Lymphoma Community
An interview with the co-discoverer of one of the biggest breakthroughs in cancer research
From causes to treatment options, get answers to your questions about CML, a type of blood cancer
New drug options on the horizon may make CML, a type of blood cancer, one of the few success stories in cancer treatment
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
