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Date of last update: 10/21/2017.

Forum Name: Head and Neck Cancer

Question: Left supraclavicular region mass

 ConcernedinColorado - Sat Jun 12, 2010 8:34 pm


I have some questions regarding an enlarged (left side) supraclavicular lymph node. First, I'll give you some history. Four weeks ago I had a sore throat. Didn't think much of it as I have some history of allergies. A week later I noticed that my lymph nodes on my left side had enlarged. Again, I didn't think much of it as I've seen the ones just under my jaw do that before with colds. I went in to the doctor and he put me on Zythromyacin (Z-pack) and the swelling began to subside. I did have some external redness (inflammation) that spread from (if I were male) the adam's apple area around the left side of the neck all the way to the spine and up into the scalp. The redness went away after a week, but the supraclavicular lymph node increased in size - to almost the size of two jawbreaker gumballs. The node was hard and not moveable. When the swelling did not go away I went back in to the doctor. He did a cat scan and a chest xray. The chest xray came back clear (yay) and the ct scan showed a line of enlarged lymph nodes in my neck. I don't have the results of that cat scan, but due to the results of it my doctor asked for a biopsy of the node ASAP. That was over a week ago now. The results of the biopsy were inconclusive and so I've been referred to an ENT doctor for an excisional biopsy. The ENT doctor suspects that it is due to infection and not cancer (as do I). Here are the results of the biopsy.

Diagnosis: Mass, left supraclavicular region, FNA: Atypical cells present (see comments)
Comments: The atypical cells in the aspirate are difficult to classify due to the extensive necrosis. This porcess may represent a necrotic lymph node from either an inflammatory or neoplastic process, but again, the extensive necrosis precludes a definitive diagnosis. Clinical correlation is suggested with additional evaluation and follow up as is clinically indicated.
Miocroscopic Description: The four Pap stained smears have abundant necrotic material with acute inflammation, lymphocytes and numerous clusters of small cells with dark round nuclei. Viable epithelial cells, clusters of histiocytes, multinucleated giant cells or viral changes are not seen.

I believe that the reason this node is enlarged is likely due to infection, but a question niggles in the back of my mind due to what I've been reading about these supraclavicular nodes. My question is, is it possible that my cold (infection) could have brought to the surface a problem in this node? Meaning, is it possible that there could have been something (perhaps lymphoma or other cancer) brewing in the node and the cold have enlarged it enough to be noticed?

FYI... I asked the doctor who did the biopsy, after he took a look at the CT scan and palpated the mass, what he thought. He stated that he thought it could go either way. He was concerned with what he saw on the CT scan. I'm a veteran and the biopsy needed to be done ASAP and the only ones who could do it are outside the VA. I went back in this past week to the VA ENT doctor and he didn't seem much concerned and decided to schedule the excisional biopsy for 2 weeks away (on the 22nd of June). I'm just a little concerned and would like to hear what the doctors here say. Thanks for your time - I know this was a long post.
 Dr.M.Aroon kamath - Tue Jun 15, 2010 6:34 am

User avatar Hi,
Your history is very akin to the description of the condition known as erysipelas. Most cases of erysipelas are due to Streptococcus pyogenes (beta-hemolytic group A streptococci).Sometimes, non-group A streptococci can also cause this.It is primarily an infection of the skin(unlike cellulitis).

Commonly, a feeling of general illness, high fevers, rigors, fatigue, headaches and vomiting, occur within two days of the initial infection.Typically,Erythematous, skin rash with charecteristic raised borders & orange peel-like feel apppears. This can occur anywhere in the body but most common over the legs,arms & the face.

Acute lymphadenitis in the area of drainage of the affected skin is fairly common.Sometimes the lymphadenitis may persist as a chronic lymphadenitis.

Only your doctor who treated you will be in a better position to make a firm diagnosis.However, if the persisting lymph node is worrying(hard consistency), one should either repeat an FNAC or perform an excision biopsy.
Good day!
 ConcernedinColorado - Sat Jun 19, 2010 4:51 pm

Hello Doctor! Thank you very much for your reply. I didn't mention before that the skin was smooth - not like an orange peel... it just was inflamed. This lasted about 5 days from the beginning until it was completely gone.

I visited with my ENT doctor/surgeon on the 16th. He felt the node and stated that it had not gone down in size and was hard. He had expected it to go down in size. He stated that we are definitely doing the excisional biopsy on the 22nd. I'm of two minds on this whole situation. That this is just a reactive node that has not gone shotty or that it is some sort of cancer (lymphoma or metatastic). It seems to me that it has grown a tiny bit in size, but that may just be a bit of paranoia on my part.

I am really interested in knowing if the infection and subsequent swelling could have brought an existing (cancer) problem to the surface. Thanks again for your time doctor. I appreciate that you took the time out of your day to respond to my query.
 Dr.M.Aroon kamath - Fri Jun 25, 2010 12:35 pm

User avatar Hi ConcernedinColorado,
Thanks for your update. It was my pleasure to guide you to the extent i could.Hope you will be OK soon. Good luck!

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