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Have enlarged lymph nodes in neck, weight loss, night sweats. Family history of lymphoma and leukemia. Worried

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Internal Medicine Specialist
Practicing since : 1996
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I have enlarged lymph nodes in my neck (have been there for about 3-4 months, and had a FNA biopsy of one of them in my neck. Combined with extreme tiredness, night sweats and weight loss of 11 lbs in the last two months, my Dr was trying to rule out a malignancy of some kind, especially since I have a family history of leukemia and Non-Hodgkin's lymphoma. The results from Pathology showed that there is a reactive process going on but in the samples taken, there were no malignancies found. She wants me to see an endocrinologist. I have not had allergies, colds, or the flu for over 6 months, so she is not believing that this is the cause of the reactive lymph nodes. I was born without a thyroid gland, but at last bloodwork, my TSH, T3 and T4 were within normal range. What could be some causes of the reactive lymph nodes? What would an endocrinologist look into? I have tested postive for Lyme Disease in 2006 and mono in 2008, however my PCP does not believe that this could be the cause of the recent symptoms along with the reactive lymph nodes..Any guidance or questions that I should ask an endocrinologist at my appointment, or any possible causes of my symptoms that we can be overlooking.
Posted Thu, 2 May 2013 in Lymphoma
Answered by Dr. Prasad Akole 4 hours later
Dear friend, welcome and thanks for entrusting your query here at Healthcaremagic!
I am Dr. Prasad Akole (Critical Care Expert- and am glad to address to your query here.

Significant weight loss, night sweats, lymph node enlargement in the neck I the absence of a recent infection in the upper body areas and a strong family history of lymphoma strongly point to a possibility of a lymphoma in the nodes.
Commonest cause of nodal enlargement is of course infections and a course of antibiotics for 7-10 days is warranted before conclusion about reactive nodes.
Leukemia/ lymphoma, other cancers, granulomatous diseases like tuberculosis and others are good differentials in such a case.
You have undergone a FNA (fine needle aspiration) which may miss a representative area affected by these diseases and only shows reactive picture if from adjacent areas.
A surgical lymph node biopsy is needed from biopsiable nodes in the neck (usually under local anaesthesia) and expert pathological impression about lymphoma is obtained.
A further search for any other sites of enlarged nodes must be sought (groins, armpits, in the abdomen and chest). It requires sonography and a CT sacn of the thorax and abdomen/pelvis.

Complete blood lab (routine), ESR, liver function tests are essential.

Absence of thyroid in the neck (what test was done?) with normal thyroid hormone level indicates the possibility of an ectopic thyroid. You may ask the endocrinologist about this possibility of a thyroid tissue at abnormal locations within your body (which secretes the hormones).

I hope to have answered your query satisfactorily. I would be glad to answer any further queries.
Take care and please keep me informed of your progress at
Good Luck!
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