Hi and thanks for the query,
It is very important to note that swollen lymph nodes and fever deserve a proper evaluation. I ma happy that your ENT surgeon has taken off time to do an in depth investigation with respect to this, but I still other suggestions.

To begin with your main worry, what you describe is very compatible with tonsil stones. However, recurrent fevers in association to these stones imply there is an infectious focus that must be well evaluated for. Enlarged tonsils and this clinical picture could be quite indicative of an abscess within, either hot or cold. It would also be interesting to know exactly whether the periods when you have fever strongly coincide with tonsil pain or aggravation of the swelling or not? If this is the case, it would imply that you are simple experience recurrent infections due to the same germ.

However, the combination of recurrent fever, tonsil enlargement and lymph nodes elsewhere deserve other in depth investigations. Removal of these tonsils and doing a proper biopsy to exclude any tumors (lymphoma) or tonsil tuberculosis are very important. Removal of the tonsils shall be certainly a definitive treatment in case its a recurrent infection from a particular germ, stones or an abscess. Added to this, other less common but serious possibilities like the lymphoma and lymph node/tonsil tuberculosis would be excluded. Other examinations to evaluate
the integrity of nearby structures like the chest X XXXXXXX could be very important. A full blood count with white blood cell levels could give indirect ideas of other possible causes.

I suggest you comply with the suggestion of your ENT specialist. The surgery is not very invasive today and offers both treatment and diagnostic opportunities.

Thanks and hope this helps. I should be honored to address any further concerns if need be.

Best regards,
Luchuo, MD.

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Hi and thanks for the XXXXXXX update,

from the XXXXXXX reply you supply, its good most of these tests tests have been done already. Their being normal actually decrease the chances of a lymphoma, but I am afraid does not eliminate completely the possibility. But however, I still think a biopsy of these lymph nodes for pathologic examination still remains the mainstay to be completely sure it is not a lymphoma or some other serious disease (other kind of tumour, Lymph node/tonsil tuberculosis, sarcoidosis) that could still present as such.

I still hold to the ENT specialists opinion of surgery, pathologic examination of the removed tonsils and a lymph node biopsy for proper histopathologic examination to be very sure and exclude any serious disease.

Thanks once again and hope this helps. I am ready to respond to your queries if you got any, so feel very free.

Wishing you good health.
Luchuo, MD.

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Hi and thanks for the query,

The other possibilities proposed in this case are not to be completely discarded. But it is good and scientifically sound to exclude:

1. 1st conditions that are more common
2. 2nd conditions that could be more severe.

After exclusion of a lymphoma or other tumor, it would be more comfortable taking time to exclude or simple and easy to manage pathologies. I strongly believe the needle aspiration still has its place in the diagnosis of tumoral conditions. I suggest you wait for the results, though a biopsy is far more sensitive. However, as I said, the needle biopsy is still used, especially well done by experienced pathologists.

Thanks and best regards. Do not hesitate asking further questions if need be.

Luchuo, MD.

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Hi and thanks for the query,

If you have experienced some swelling, I am of the same opinion like you that it should be associated to the biopsy.

Thanks for the update and best regards,

Luchuo, MD.

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