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Forum Name: Lymphoma

Question: generalized lymphadenopathy and other symptoms


 Lalig126 - Thu Aug 28, 2008 6:06 pm

I am a twenty year old hispanic female and about a couple of months ago I started feeling a pain near my right arm, but I couldn't determine specifically where the pain was coming from. I thought it could possibly be a lymph node so I when I went for my annual check up to my GYN she performed a clinical breast exam and reassured me that everything was OK. At the time I had been taking birth control for a couple of months and my breasts were becoming increasingly dense and fibrous and I asked whether this was normal and she said that in many cases women develop fibroadenomas or fibrocystic breasts due to birth control. She reasurred me that everything was fine and if I noticed any other changes in my breast to return and said that the pain was probably related to my joint/muscle and suggested that I probably "slept wrong" or did some kind of activity that aggravated the area. I had been asymptomatic for about 2 months following that and the pain practically disappeared. Recently, however, I have been suffering from terrible headaches, pain in my joints and they crack all the time (especially the shoulder, elbow, hands, knees and ankles), I've had low grade fevers, back pain, malaise, loss of appetite and I lost about 5 lbs in 2 weeks. I went to the ER because my pain only got worse and I was on the verge of tears and they did a CT for my brain since I had been having recurrent headaches, blood pathology (CBC), and urinalysis. They said the CT came back negative, the blood tests came back within normal ranges and the urine was negative for UTI and my kidneys were functioning well, I just had mild dehydration. My doctor said that my headaches were migraines/tension headaches that were stress related and that all the other symptoms were indicative of a virus. I questioned about my submadibular and submental lymph nodes which were a bit swollen and tender and he said that they were "slightly" swollen and tender because of infection. He reassured me that due to my age and history I was probably trying to fight off some kind of infection. He told me to get some rest, eat well and drink plenty of water and if the symptoms persisted to return, but to give it about 2 weeks.

If I had a virus wouldn't by WBC count be elevated? And why would I have other symptoms such as joint pain, etc?

I'm a student nurse and I felt like his diagnosis was a bit vague and perhaps he didn't run enought tests.

My appetite comes and goes and I feel nausea but I was able to gain some of the weight back (2lbs). HOWEVER, I feel like my lymph nodes everywhere are out of wack! I can palpate my supraclavicular lymph nodes (bilaterally) and in my groin and recently I feel some upper left abdominal pain which tends to increase when I do heavy lifting or moderate activity. To top things off, I feel nodule-like lumps under my skin in my abdomen, arms, and thighs...SO basically I am terrified. My chest also feels tight sometimes and I feel gasy. ALL the research points to cancer or some kind of malignancy and my father passed away from metastatic prostate cancer in the brain at 54, so you can imagine the trauma I have; not to mention, my paternal grandfather-liver cancer (although he was an alcoholic), my maternal grandmother-lung cancer (heavy smoker since the age of 14), and my maternal grandfather-metastatic lung cancer in bones (probably from my grandma's second hand smoke).

ALSO, I recently was diagnosed with an ovarian cyst, so I feel like my body is completely out of tune. PLEASE HELP!

I have scheduled a doctor's appt for tuesday but I need some insight or peace of mind until then because I am so scared. ALSO if you can please tell me what questions I should ask the doctor or what tests I should request.

Thanks in advance
 Dr. Safaa Mahmoud - Wed Oct 15, 2008 2:13 pm

User avatar Hello,

Breast consistency differs based on changes in the blood levels of female hormones, thus exogenous hormones like those contained in the contraception pills induce breast changes as your doctor explained. Regular self examination and clinical examination is important to follow up these changes and to exclude a suspicious breast nodule. Bilateral small axillary nodes that are less than 1cm, mobile, rubbery to firm are commonly seen in females with fibroadnosis of the breast.

Submental and submandibular lymph nodes drain the teeth, the gum and the lips. While inguinal nodes drain the genital, the anal area and the lower extremities. Following infection or inflammation in the area drained by them, they grow in size and become painful. When infection or inflammation subsides they regress in size but never disappear.

Nodes are generally considered to be normal if they are smaller than 1 cm in diameter; however, for inguinal nodes, those larger than 1.5 cm are generally considered abnormal.

Those small nodules you feel in the abdominal wall are more likely to be subcutaneous fat rather than abdominal lymph nodes that are detected by radiological examination. I assume that your doctor made sure that the supraclavicular swellings represent fat collection and are not lymph node enlargement. If they are truly LN, they should be considered very suspicious and should be carefully investigated

Your investigations are all normal and CT scans are free of any disease so your condition is most probably not related to cancer. viral infections causes similar clinical picture and having a normal CBC does not exclude its occurrence.

I would advise you to closely observe these lymph node and to follow up with your doctor. A thorough examination of all lymph node groups is essential. Complete blood picture, liver and kidney function tests, ESR, LDH may be recommended too. Thyroid function tests and CT Scans as needed. All investigations are requested based on complete history and physical examination.

Hope you find this information useful.
Please Keep us updated.
Best regards.
 Lalig126 - Thu Nov 20, 2008 3:55 pm

First and foremost, thank you so very much for your feedback, I really appreciate it.

Well I returned to the doctor because I was feeling a lot of malaise and muscle/joint aches and they ran a slew of exams including:
CBC, electrolyte panel, ESR, CRP, liver function tests, glucose, lipids, immunology tests (RF, ANA, Smooth muscle IgG, ASO titer), chest Xray and the doc told me to choose a joint that had been hurting to avoid exposing my body to radiation so they did a wrist Xray.

Everything came back within normal ranges and the chest and wrist xrays were normal, negative for any acute process, and 'unremarkable'. The one thing that came back elevated was my ASO titer which was at 611 and the doc said the normal range for adults was 0-200.

He prescribed penicillin VK 500 mg BID and did a throat swab for which I find out the results this upcoming week. I still have a sore throat and the area under my jaw line is very tender. I have a lymph node right under each ear that is very swollen and painful to the touch (I would say about 1-1.5cm in size). Ive recently been having tinnitus and ear ache and when I touched behind my right ear yesterday because I kept having a lot of pain I have about 2 pea sized nodes.

Could this be due to the strep infection also? What if the throat swab comes back negative but my ASO titer was + ?

I am really scared about lymphoma. Whenever I look up anything EVERYTHING points to cancer and it is really scary/frustrating when I have to wait weeks between each appointment.

PLEASE give me some info about this, I will really appreciate it. I am a student nurse and I can barely focus on school because I am really stressed out over this whole situation.

THANKS IN ADVANCE and hope to hear from you soon.
 Dr. Safaa Mahmoud - Sat Dec 06, 2008 3:31 pm

User avatar Hello,
Sorry for the delay in replying and hope you are better.

If your ASO titre is high it indicates recent infection with streptococci (most common cause).
I agree with your doctor that you should receive a full course of antibiotics (penicillin) then your tests should be repeated.

As for these lymph nodes, the ear pain and the throat pain, they are going with streptococcus infection in the throat, so do not be stressed and follow your doctor’s instructions. A serial clinical examination of these lymph nodes is essential too.

Please keep us updated.
Best regards.
 Lalig126 - Mon Apr 06, 2009 10:36 pm

I just wanted to let you know that I have been going to an ENT who specializes in ear/throat cases and he had me under observation for 6 weeks to see if he noted any difference in my lymph nodes and after 6 weeks he noticed they were practically the same. He says that what mainly concerns him is the swelling below my left ear because he can't distinguish between lymph node or whether it is connected to the parotid gland. But he said that given my history and because I didn't have any other accompanying symptoms of weight loss he didn't think it was anything bad but rather reactive lymph nodes of a previous infection/chronic infection. I have still been experiencing some right ear pain every so often and have congestion, and my lymph nodes are painful every now and then. BUT to rule out anything bad and because I have been so worried he referred me for a CT of the head/neck with and without contrast. The person performing the CT said that it clearly showed Left Maxillary Sinusitis but that I had to wait for the written report from the radiologist. I have an appt this friday with my ENT for a follow up and results of my CT (crossing fingers), so hopefully everything will be cleared up! I have been super worried all of these months and now at least I will get some answers as to why the nodes in my neck have been swollen for 7 months.

I was just wondering what could be determined from the CT? lymph node size, etc...like how reliable is it? and if they find something abnormal, what is the next step? biopsy?

Thank you for your feedback, I really appreciate it.
 SoVeryTired - Thu May 07, 2009 5:47 pm

I am a 47 caucasion female, our family has a history of Heart and Cancer. On March 18 of this year my Lymph Nodes started swelling, at first it was a couple, then they just became worse. I now have Lymph Nodes everywhere under the arms, groin, etc. I have lost over 65 lbs. and I am sitting around 100 lbs. 2 Biopsies have been performed one removing a large Lymph Node on the left side of my neck and a Lesion Sample as I started to develop these Boils. Well it has been 1 week since the Biopsies. The doctor called me in and I am being referred to a Hematologist and he said they would probably do a Bone Maro Test. I am so scared and so confused. My doctor is absolutely wonderful I guess I am trying to understand what I might be possibly looking at. Obivously at this point everything is speculation, but where the Lymph Node was removed for the Biopsy it has now been replaced with an even larger Lymph Node. I am nauseaus all the time, very run down, sleeping a lot and not hungry, but once I take my gravol to ease the nauseau I try to eat as much as possible. No matter what I do I can't seem to gain weight. I understand that until all the tests are done there really isn't an answer, but even if I had a rough idea of what could be going on. Lymph Nodes on my back shoulder area causing pressure and pain, my neck looks horrible as the Lymph Nodes are so swollen and the sores are disgusting and they weap. Can anyone help me understand it is like my body is rebelling on me. SoVeryTired

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