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- Sun Dec 10, 2006 3:14 pm
Question: Should I proceed with biopsy?
I have been referred to a surgeon for an excisional lymph node biopsy in my neck. My doctor thinks I am probably just fine, but is still sending me to surgeon because the lymph node hasn't shrunk.
Age: 43, Sex: F, Race: northern european
2004-present: night sweats (must change bed clothes in middle of night). Occurs occasionaly (maximum of 4x month). May just be perimenopause.
June 2006: Diagnosed with bilateral, multi-dermatomal herpes zoster. Outbreak presented in right trigeminal nerve and left back and arm. Bilateral zoster is extremely rare and is usually associated with a significant compromise of the immune system (AIDS, malignancy, etc.). Herpes Zoster in patients younger than 50 years suggests the possibility of underlying immunosuppressive condition.
June 2006:diagnosed with Hashimoto's thyroiditis. Titrated (Synthroid) to optimal levels as of November 2006.
September 2006: diagnosed with fibromyalgia (I have had it for years, and it is mild).
September 2006 to present: aching spleen; and enlarged right submandibular (or maybe jugular) lymph node >1cm. Lymph node is painless, rubbery, and gets bigger at night or when I have a cocktail.
November 2006 to present: unusual unexplainable dark bruising on legs. I have not had such bruising before.
-CT Scan shows non-specific splenic lesion, otherwise chest & abdomin look clear. They did not perform scan of neck.
-Blood tests ruled out Strep, Mono, HIV, SLE, HepA, HepB, HepC
-EBV past exposure: positive (VNA high, EBNC high)
-Sed rate: normal
-Lymphocyte count: low in August, normal in October.
-MPV - high
-Urine tests: normal
Thank you for any insights you may have.
| Dr. Tamer Fouad
- Tue Dec 12, 2006 4:31 pm
Your doctor would be better at answering that question than me. If there is even a slim possiblity that you may have lymphoma then its always best to get a biopsy.
This should be conducted on any significantly enlarged lymph node. However, lymph nodes of the head and neck are a bit more tricky. First they are usually more difficult to excise than the axillary lymph nodes. Second I would personally recommend a CT scan of the head and neck first before going on to doing a biopsy from the neck.
Sometimes lymph nodes of the head and neck are not lymphoma but could be due to a head and neck cancer. By performing a biopsy of neck lymph node some say you may compromise the efficiency of head and neck radiotherapy by distortion of the muscular planes.
Just because your doctor referred you to a surgeon for a biopsy doesn't mean your surgoen will do it right away. He will evaluate your condition and whether or not a biopsy is performed will depend on his assessment.
Keep us updated.