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Forum Name: Lymphoma

Question: biopsy question


 kdsjager - Sun Jul 02, 2006 1:48 am

i am a 34 yr. old female.my problems have been---painless,swollen lymph nodes in neck,collarbone,groin,backs of knees and lower back,severe itching,drenching night sweats,severe constipation,bleeding between periods,lower back pain,lower abdominal pain,weird headaches,unexplained bruising,little red dots under skin,bone ache,extreme weight loss(12% in 4 months),loss of appetite,loss of muscle,extreme fatigue,pain in lower back,neck,and side when drinking tiny amounts of alcohol.i've been tested for EVERYTHING.BMB was normal.now the hematologist has told me i'm on a watch and wait schedule because it may be cancer but have to see if it presents with something more.i've been told that my nodes were too small to biopsy.the ones in my groin have gone from about a 1/4 of inch to almost 1 inch in one month,and have become very hard. i just need to know,how big does it have to be before they can biopsy it? if i can feel it just under the skin and it's hard as a rock, can't they take it out?they couldn't possibly mistake it for fatty tissue,which is why the surgeon said he couldn't remove it before the BMB(it has changed since then,2 weeks ago).i will be scheduled for a PET scan in 2 weeks,but does it make accurate diagnosis? i just want to get a diagnosis,so i can get treatment.and yes,all blood tests were normal.when i say i was tested for everything i mean tb,hiv,mono,epstein-barr(past infection),thyroid---the works.just for the record, my bruising has just started within the last 4 weeks.huge ones where i cannot explain them. i'll go to sleep without one and wake up with 5 inch bruise,that kind of thing.forgot to mention voice has become hoarse,too.sorry to be so long.my uncle died of leukemia at 20,and my brother died of ruptured aortic aneurysm at 30(possible Marfan).6 aunts with cancer-1 died as result,5 female cousins with cancer,grandfather died of lung cancer.can someone please offer me at least something to help convince dr. to do biopsy? (prob. should mention,problems started about 8 months ago,and have been getting worse every week till lately ,now it seems something else happens to my body almost every day. thanks,kds
 Dr. Tamer Fouad - Sun Jul 02, 2006 4:37 pm

User avatar Hello,

l am sorry to hear about your complaints.

Nodes are generally considered to be normal if they are up to 1 cm in diameter; however, some authors suggest that epitrochlear nodes larger than 0.5 cm or inguinal nodes larger than 1.5 cm should be considered abnormal [1,2].

Little information exists to suggest that a specific diagnosis can be based on node size. However, in one series [3] of 213 adults with unexplained lymphadenopathy, no patient with a lymph node smaller than 1 cm2 had cancer, while cancer was present in 8 percent of those with nodes from 1 cm2 to 2.25 cm2 in size, and in 38 percent of those with nodes larger than 2.25 cm2. These studies were performed in referral centers, and conclusions may not apply in primary care settings.

In children, lymph nodes larger than 2 cm in diameter (along with an abnormal chest radiograph and the absence of ear, nose and throat symptoms) were predictive of granulomatous diseases (ie, tuberculosis, cat-scratch disease or sarcoidosis) or cancer (predominantly lymphomas) [4].

An increase in nodal size on serial examinations is significant. Hence nodes that continue to grow in size are important and those that regress in size tend to be more reassuring.

Stony-hard nodes are typically a sign of cancer, usually metastatic. Very firm, rubbery nodes suggest lymphoma. Softer nodes are the result of infections or inflammatory conditions. Suppurant nodes may be fluctuant. The term "shotty" refers to small nodes that feel like buckshot under the skin, as found in the cervical nodes of children with viral illnesses.

PET scans are very helpful in the diagnosis of cancer. I suggest you discuss the above information with your doctor. He is the best judge of the situation.

References:
==========
1. Libman H. Generalized lymphadenopathy. J Gen Intern Med 1987;2:48-58.
2. Morland B. Lymphadenopathy. Arch Dis Child 1995; 73:476-9.
3. Pangalis GA, Vassilakopoulos TP, Boussiotis VA, Fessas P. Clinical approach to lymphadenopathy. Semin Oncol 1993;20:570-82.
4. Slap GB, Brooks JS, Schwartz JS. When to perform biopsies of enlarged peripheral lymph nodes in young patients. JAMA 1984;252:1321-6.

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