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Developed chronic sore throat, spongy lump at the base of neck. Mono negative. Any thoughts?

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General & Family Physician
Practicing since : 2009
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I am a 58 year old caucasion female with minimal cancer risk factors. I don't smoke, drink and am 5'7 and 170 lbs. I developed a chronic sore throat, hoarseness, spongy lump at the base of the neck 'v' area. I have been increasing tired over the past 4 weeks and have some mid lower quadrant pain in the past few days. I have seen the doctor three times. Mono spot test at 3 weeks was negative. I am a self-employed RN Psychologist and have been working too much in the past 2 years as I started my own practice. I take progesterone for post-hysterectomy (15 years). I have ruled out depression, take Zoloft and Concerta for Adult ADHD, and the lumps on my neck are tender but have not changed much in the past 4 weeks. The family MD I saw today was completed stumped and after my encouragement has drawn, CBC, Sed-rate, IG, Epstein Bar Virus titer, Thyroid, TSH, and plans to do an ultrasound. I have decided to take the rest of this week off to focus on my diet and increasing excersise as I have been working my through this thing. I'm basically healthy, no diabetes, high anything. Any thoughts?
Posted Tue, 2 Apr 2013 in Infections
Answered by Dr. Shoaib Khan 1 hour later
Hello and welcome to XXXXXXX

Thank you for writing to us.

In my opinion your description and location could be due to enlargement of one or more lymph nodes. If this is painless, this could be lymphoma. But, if this lump is tender and painful, these could be due to some infection and/or inflammation.

In my opinion, this lump could have been formed due to the sore throat (infection) that you are experiencing. The elaborate investigations suggested by your family MD will indeed help in finding a more conclusive cause.

This is mostly an infection and thus will be treated depending on the infection-causing organism (eg. Bacteria, virus, etc.)

I hope I have succeeded in providing you with the information you were seeking. Do write back to me for any further clarifications, I would be happy to help.

Best wishes.
Above answer was peer-reviewed by
Follow-up: Developed chronic sore throat, spongy lump at the base of neck. Mono negative. Any thoughts? 15 hours later
My GP does not seem concerned about the mass being cancer. The mass is at the "V" in my neck. It appeared 2 weeks into this sore throat, headache, fatigue, loss of appetite. It is spongy, painless, movable, and has not gone down since it showed up four weeks ago. I do have some swelling in my axillary area's but no hard nodules. The tiny hard nodules are in my neck just under my chin. Very tender around the muscles on the left side. No fever, shortness of breath, just serious fatigue with sleeping 8-10 hours of sleep. Finish a trial of Z-pac at week 3 of the illness - no change. No puss in back of throat now or in past.

Being a nurse, I know that viral and illness of unknown etiology is all about wait and test, wait and test. If this is a lymphoma how soon should a person skip this process and get to see someone. What tests are going to encourage someone to send me to get a biopsy? Sorry, my GP nurse called and said the CBC, Sed Rate, and Thyroid panel were all normal. The EBV/CMV won't be back until next week. Should I move to getting the mass checked out as it is not tender but is not going away?
Answered by Dr. Shoaib Khan 4 hours later

Describing the lump to the doctor itself should make him/her think about a lymphoma. This is usually diagnosed using an excisional biopsy.

We can only confirm the presence of a lymphoma with the help of a biopsy, and nothing else. Only once a biopsy has confirmed the presence of a lymphoma can we go about other tests.

But, then again, we are assuming the possibility of a lymphoma only due to the presentation as of now, right?

Why doesn't your doctor also prescribe a slightly more stronger course of antibiotics to treat the sore throat. As you have still not found relief from this (almost 4 weeks now, this is not good follow up management) despite the course of antibiotics. As mentioned earlier, this could all just be because of an infection, but I am sure you already know that. Although, the WBC should have shown an elevation if this were the case (infection).

I think you should move to getting the mass checked XXXXXXX Why wait? I don't see why we should wait. Please go ahead with the biopsy if a doctor can help you with that. I am sure they cant put down a request if you insist.

Do keep me updated and write back to me for any further clarifications.

Take care.
Above answer was peer-reviewed by
Follow-up: Developed chronic sore throat, spongy lump at the base of neck. Mono negative. Any thoughts? 13 minutes later
I really appreciate your feedback. I am very educated and have been reading a great deal about the process when working with lymphadenopathy since this started and I think the only way to know what is happening is to do as you suggested. As I have been plagued with 'hot flashes' for many years I do have night sweats that have seemed to get worse since I have been sick. I know that if it is mono them I just have to be careful what kind of antibiotic I go on. Everything I have read said that fine needle biopsy does not work but the entire mass needs to be taken out. Is that true?

I don't have insurance but it doesn't matter, I don't want to die young like my brother (41 - heart attack) and my father (age 53 - heart attack) will do whatever I need to do to get this figured out. My mother is 82 and very healthy so it's only half the problem. This was a new GP - and I was not very impressed - maybe she didn't like my pushing as I came very prepared.

Should I try to find a surgeon? I'm seeing my OB/GYN next week she could make a referral. I have seen her for many years and trust her judgement. The hospital has a way of helping people without insurance get these things done. I am truly grateful you have taken an interest in my case. The first doctor is saw was in a rapid care unit and wanted me to go to the ER to get everything done at once. Now I"m wondering if I shouldn't have done that. Be like buying a car but to rule out cancer I think it's worth it. What do you think? As a nurse/psychologist, I tend not to jump to the worst case but also don't want to be too passage based on our poor medical system. Your thoughts?
Answered by Dr. Shoaib Khan 13 minutes later

An FNAC (fine needle aspiration cytology) will help in providing information on a lymphoma, but it will still have to be followed up by an excisional biopsy to attain more tissue samples for testing. Instead of going in for another small tissue sample, doctors prefer taking the whole mass out, which is why an FNAC is considered a procedure which we can do without.

Doctors do at times feel threatened when they XXXXXXX well-informed patients, but I consider this an added advantage as the patient can better understand and comprehend the necessity for certain protocols and investigations before reaching a diagnosis, and so on.

I feel you should visit your OBGYN, as she seems to be experienced and will surely pay more interest in your case. The referral should come from her. Do ensure she helps you out with this. It is completely my pleasure, I am only here to help.

I understand that most people like to consider the possibility of cancer only in the end, but it is a doctor's moral obligation to first rule out the worst, and gradually descend from there on. Thus, I feel it completely worth a shot, to rule this out.

Medical systems are always present for a reason, sometimes or rather most times, it takes more time than usual to reach a diagnosis, which shouldn't be the case, but this is only to ensure the safety of medical practitioners, so they can only inform the patients about a certain diagnosis after confirmation from a number of their colleagues (thus the referrals).

I should let you know that you are one of my first patients who is this well informed. I am happy to help. It is a real pleasure communicating with you. :)
May god bless you with a long, beautiful and healthy life.

Best wishes XXXXXXX
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