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Painful Enlarged Lymph Node On The Neck. Malignancy Chances?

Posted on Thu, 21 Jun 2012

Question: Hi Dr,

I went to the doctors as there was a noticeable lump under my neck (to the left) - been there for about 6 weeks now and got bigger. He claimed it was a cyst that needed to be removed. I went for an ultrasound and they were able to completely rule out a cyst and in actual fact ended up discovering an enlarged lymph node.

ultrasound results (below):

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There is a well circumscribed highly vascular rounded mass just to the left of midline within the sublingual area measuring 11 x 8mm.

Both SMG appear normal.

At the base of the left neck at the anterior chain is an enlarged lymph node measuring 27 x 12mm which is highly vascular.

No other unusual masses seen within the neck or supra clavicular fossa.

In light of these findings Malignancy must be considered.

Impression:

Suggest urgent follow up imaging such as MRI to assess extent and nature of mass and Lymph nodes.

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The blood test results have come back with the below comments:

''Neutropenia.
Reactive lymphocytes seen suggest check virology. If symptoms persists consider lymphonode biopsy''

I have an ENT appointment Friday 6th XXXXXXX 2012 at 10:15am.

Please can you let me know what you think? I now have pain over the left side of neck too...

Thanks in advance

Answered by Dr. Sumit Bhatti (4 hours later)

Hi,

Thank you for your query.

1. A painful enlarged lymph node will usually be a reactive lymph node due to an infection.

2. Increased vascularity in the lymph node may signify inflammation or malignancy.

3. FNAC (Fine Needle Aspiration Cytology) of both the sublingual mass and the lymph node will give a fairly accurate diagnosis. Both the Histopathology reports can be co-related.

4. In the case of a doubt, a Magnetic resonance imaging (MRI) with contrast and an open biopsy will settle the issue.

Hope I have answered your query. If you have any follow up queries I will be available to answer them.

Regards.

Above answer was peer-reviewed by : Dr. Aparna Kohli

Follow up: Dr. Sumit Bhatti (5 hours later)

Hi,

Thanks for the answer but it doesn't really give me anymore information to the situation at all. All 4 points were more or less entered in my question. I thought you may be able to help with more detailed information.

Regards

Answered by Dr. Sumit Bhatti (42 hours later)

Hi,

Thank you for writing back.

1. A FNAC of the mass and the lymph node, followed by an MRI with contrast with an open biopsy in case of doubt is the standard protocol that is followed in these cases. There are about 300 lymph nodes in the head and neck region alone.

2. There is really no more information possible at this point of time without the investigations and a physical examination.

3. If this mass is in the sub mental triangle (an area in the neck just below the chin) , there are only a few important structures which can give rise to such a swelling. These include the submental lymph nodes, sublingual salivary glands, muscles of the floor of the mouth and tributaries of the anterior jugular vein. Other rarer vascular masses include hemangiomas and tumors.

4. To avoid alarming yourself, evidence based medicine requires the above tests to be done before an explanation or diagnosis is offered.

Wish you a Happy New Year,

Regards.

Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Aparna Kohli