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Forum Name: Lymphoma

Question: Seemingly generalized painful lymphadenopathy


 branwen - Thu Jul 05, 2007 7:56 pm

Hello,

For the past month and a half, I have had several slightly swollen but tender lymph nodes in different places on the left side of the body, and I am very concerned.

I am a 32 year old female with a history of hypothyroidism and depression/anxiety (taking Wellbutrin and sertraline). I first began noticing painful left side cervical lymph nodes that were swollen - moveable and squishy and a few days later noticed a swollen inguinal lymph node on the left side that was also moveable and soft. Additionally, I have history of fibrocystic breasts, frequently with pain on the left side of my left breast which radiates to my left armpit. I have palpated this region and I do not feel any enlargement but there is a pressure there.

After discovering these swollen nodes, I went to the doctor, who palpated these nodes and did not seem overly concerned. I had a CBC which was "normal", Because these symptoms did not go away, I again went to the doctor (different one) who was not overly concerned either and had another CBC done which was also normal. At that time, my TSH was tested and it was normal as well. I have also seen my gynecologist who did a pelvic exam which seemed normal. My last pap was in Novermber which was also normal. My only history of recent infectious illness was in March in which I had a terrible sore throat/fatigue and swollen nodes in these areas (including inguinal) on the left side. I had also had a mole (described below) removed the same week of that infection.
I recently had two cavities filled on the left side, but the swelling/pain in my neck still has not disappeared nor has my inguinal node. At this time, the inguinal node pain is radiating to my left pelvic bone area. I had had no fever, night sweats, or weight loss.

I have already had mono and a TB skin test which was negative. The only other injury that I have had is a mole that was removed on my stomach adjacent (left side) to the belly button. This mole has a history of being atypical and has grown back twice but pathology always says that we have gotten it all.

I am making myself sick with worry, particularly because I can feel the pain/pressure constantly. Is it possible that these are two seperate issues (different causes for different regions) or related? Should I go to the doctor *again*?
Thank you for your help!
 Dr. Tamer Fouad - Fri Jul 06, 2007 9:05 pm

User avatar Hello,

Generalized lymphadenopathy is always a puzzling entity. The presence of fever may suggest an infectious cause or lymphoma. The presence of rash may suggest an infectious or autoimmune process. We tend to request a full blood count to exclude hematological causes. A lymph node biopsy is needed if the picture is suggestive of lymphoma.

Essentially 5 broad etiologic categories lead to lymph node enlargement (Ghirardelli, 1999).

An immune response to infective agents (eg, bacteria, virus, fungus)
Inflammatory cells in infections involving the lymph node
Infiltration of neoplastic cells carried to the node by lymphatic or blood circulation (metastasis)
Localized neoplastic proliferation of lymphocytes or macrophages (eg, leukemia, lymphoma)
Infiltration of macrophages filled with metabolite deposits (eg, storage disorders)

Infections
    Infectious mononucleosis.
    Cytomegalovirus may cause a syndrome similar to infectious mononucleosis.
    TB: In a child with tuberculosis, generalized lymphadenopathy may indicate hematogenous spread of tubercle bacilli.
    Brucellosis may accompany chronic or intermittent lymphadenopathy.
    Salmonella infection can correspond to generalized adenopathy.
    Tularemia may be accompanied by regional or generalized adenopathy, most commonly cervical, with local tenderness, pain, and fever.
    Bubonic plague is caused by Y pestis.
The list goes on and on. You may want to look at a more exhaustive list here. The thing to remember is that in many instances the immune system can overcome the infection and what is left is a number of small lymph nodes that tend to remain more or less the same size.

Naturally I am unable to help you reach a diagnosis through the internet but what I can do is answer your last question. It would be safe if you were examined by a doctor he was not concerned. As to when you should consult your doctor again: if there is an increase in the number or size of the enlarged lymph nodes or if any new symptoms arise.

References:
1. Ghirardelli ML, Jemos V, Gobbi PG: Diagnostic approach to lymph node enlargement. Haematologica 1999 Mar; 84(3): 242-7.

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