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Have tonsils removed. Developed painless, immovable lump on side of neck. What test should be done?

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Pediatrician, Surgery
Practicing since : 2003
Answered : 246 Questions
I developed a marble sized lump that is painless, immovable, on the left side of my neck. If you we're to take your finger from the left earlobe, and proceed down t where you feel the first curvature of the jaw, and go posterior about 2 inches, that's where my lump formed. I saw my doctor 4 days ago the day after I discovered it, and was only told to wait two weeks and return if the lump has not gone away. I have not been sick at all in the last 6 months, and I do have my tonsils removed. This morning I found another lump, bigger, about 1/4 inch above and slightly more anterior than the first. This lump is also painless, immovable, and hard to the touch. The hospital I go to is notorious for beating the bush with issues (Madigan army medical center)...I just want to know realistically what I'm possibly dealing with here and what type of care I should request, what type of testing should be done, etc. I am a surgical technologist, and while I am not a physician, I do know a great deal about what can be done, and I refuse to feel as if I'm being dismissed without concern involving these lumps. Any opinions would help. Thank you.
Posted Sat, 27 Apr 2013 in Lymphoma
Answered by Dr. Anand Sinha 4 hours later

Thank you for placing your query with Health Care Magic,

I can understand your concern about such swellings. The most common explanation for such swellings in the neck would be enlargement of lymph nodes. There are various causes for such enlargement (or lymphadenopathy).
1. Reactive lymphadenitis: The lymph nodes in our body act as defence mechanisms. So whenever there is any infection or injury, the lymph nodes of that region get enlarged to fight it off. Even when the causative disease is over, they persist to remain enlarged and take variable periods of time to get down to normal sizes. When they get enlarged in response to an infection they are called reactive lymphadenitis. The lymph nodes are per se not infected, but are just an indicator of underlying infection. That is the commonest cause for lymph node enlargement and hence your treating doctor must have asked you to wait for two weeks. These kinds of nodes are small, mobile, not painful to touch, just as you have described. If that is the case, then you need not worry and they will resolve once your infection is treated. The kind of infections that cause lymph nodes of neck to enlarge are ear infections, common cold and upper respiratory tract infections, nose infections and any trauma to head, neck or face.

2. If the lymph nodes get infected themselves, they form an abscess. But it is painful, red, and warm to touch and associated with fever. Your physician would definitely have not sent you back then. So I think it is unlikely in your case

3. Not in your location, but in certain developing nations some chronic infections like tuberculosis also form a frequent cause of lymph node enlargement. Since you are not residing in an endemic zone, I am not laying stress on it. But if you have visited any such region then you should also think on those lines.

4. Some diseases like HIV also present with lymph node enlargement. But usually they involve other parts of the body like axilla and groin too (called generalized lymphadenopathy). Again since you don't seem to have such generalized disease, I am ruling it out.

4. Some tumours also involve the lymph nodes e.g. lymphomas. It is comparatively rarer. The lymph nodes are of bigger size, more firm to touch and grow rapidly. Some tumour in the ear, nose or throat may also shed some cells which may reach these nodes and they get enlarged (called metastasis).

5. Rare diseases like storage disorders can also lead to such enlargement. But I won't go into details of those as they are very rare.

Now as for your concern,

1. If you have suffered a recent infection of ear, nose or throat and if the lymph nodes are small and not increasing in size, then they are likely to be reactive and you can wait.

2. However, to allay any anxiety you can undergo a test called Fine Needle Aspiration Cytology (FNAC) from the enlarged nodes. They will insert a small needle into the swelling and aspirate some cells and further observe under the microscope. That gives a reasonable idea as to the cause of such swelling. It will especially help in ruling out the chronic infections and tumours. It gives a reliable result in almost every case. Very rarely you may need to go for a biopsy of the node (especially if needle test raises a suspicion of cancer).

There are other causes of swellings in the neck. But none of them fits your description. And FNAC will diagnose them too. So I am not going into details.

Hope that helps solving your query... Let me know if you need clarifications.

God bless you
Dr Anand Sinha
MS (General Surgery)
MCh (Pediatric Surgery)
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