Question: General Persistent Lymphadenopathy. Hi there, I am an 18 year old fit and healthy male I am 6"2 and relatively slim. i have had a small 1cm soft rubbery,movable bump(probably lymph node) on my trapezius muscle for at least a few years with no apparent growth so i never really worried about that one. Two months ago I noticed a small bump under my chin and found two very small lymph nodes next to each other largest was about 1 cm, after persistence of about 3 weeks I saw my GP who after a brief 2 min examination ordered a round of antibiotics because he though they were due to the acne on my face. A week passed while taking the antibiotics and I noticed that one of the lymph nodes decreased slightly(2-3mm)on the fourth day in but not again after that. After some research I felt my armpits and other regions of my neck and found another sausage shaped,rubbery,highly movable, lymph node in my left armpit which again was about 1cm in length. So I went and saw my GP and he ordered a blood test which came back fine. A week later I found another 2 easily movable, smooth, and rubbery 1cm lymph nodes in my posterior cervical region on the left side of my neck. This was concerning because from what Ive gathered on the internet lower neck lymph nodes swell usually due to malignancies. So I freaked out and asked my doc for a referral to a surgeon for biopsy. Yesterday was my appointment with the surgeon, he felt the lymph nodes in my neck and armpits and decided he wasnt concerned and that we should wait 3 months to see if they grow before doing a biopsy. However I forgot to tell him about the lymph node on my trapezius muscle and I dont think he felt the largest lymph node in my lower right underarm(2cm, easily movable, and rubbery) so now I am left wondering if he would have been surprised by these lymph nodes and instead done a biopsy. Now the thing is I havent been having any other symptoms and my blood tests have been fine thus far. Most of the nodes are all 1cm or smaller, painless, rubbery, and highly movable and I have no idea how long some of them have been there because Ive never looked for them, I only found them when I searched thoroughly through every inch of these parts. another thing is that my left shoulder has been sore on and off, so I am wondering if that 1cm node on my trapezius(thats been there for at least a year) could have been causing the pain and if so is actually something serious, and if it is due to the fact that my brain is so close if it is lymphoma it could spread to my brain as well. I know I sound a little hypochondriac but this is the first time in my life I've been this worried and anxious about something. I hear about so many misdiagnosis on the web with regards to lymphoma and they really freak me out so I cant help but wonder if I fall into the category or whether I should just trust my doctor and surgeon. On one hand they(doctor and surgeon) know what theyre doing, and none of my lymph nodes are that big or have been growing, blood tests are fine, no symptoms, nor do I know how long alot of these have been around etc. On the other I am worried that this could be an indolant lymphoma that could spread to my brain due to the fact that one lymph node is so close, plus the nodes themselves are painless and rubbery(another sign of lymphoma), an indolant lymphoma would also explain my lack of symptoms as well. Should I get a third opinion from another doctor or am I just worrying unnecessarily?  also, i have also noticed that a chain of 3 lymph nodes all around 1cm or smaller are palpable from my lower left posterior cervical region down to just above my supraclavicular area. i have done research and it says these are usually malignant so now I am very worried. They are all small,painless, rubbery, and movable.

Xray results will be in on Monday. 4 weeks ago I was on a 7 day course of clydamycin and on the 4th day I noticed a very decrease in size maybe 2mm of the submandibular node but it may have been just in my head so I take it with a grain of salt. Also if I had lymphoma according to my aunt, it would be stage 2b because I have no symptoms and its on both sides of the diaphragm in multiple nodal areas. So if it was at that stage wouldn't there be a slight hint in my blood tests? And wouldn't I feel at least a little "off" if you will? Does having so many small mobile nodes that haven't changed noticeably in the past two weeks favour a benign cause or is this quite common in most lymphomas? Also according to my aunt a chain of lymph swollen nodes from the posterior cervical to the supraclavicular area is a general sign of a malignancy and almost always rules out infectious causes. Plus my surgeon never palpatated the supraclavicular node because it is hard to find and quite small although it is located just below the other two nodes in my posterior cervical area. In your practice as a surgeon, when you feel a lymph node can you normally tell if its upon palpatation if its concerning? Thanks so much for your time

OK so in your examinations, do you frequently see persistent general lmyphadenopathy like mine? Also I have done some research and it says that sausage shaped nodes are benign 97% of the time, is this true or just internet nonsense? I have just palpated the thicker part of my lower armpit and have found several other small movable nodes on both sides along with the larger 2cm movable node on my right armpit they are all very small as well.

Sorry doctor I know I sound very anxious and worried. In your examinations do you occasionally have palpable supraclavicular nodes in patients I am also told this is abnormal to feel any of these? Sorry again for sounding worried and a little anxious

I already have, I waited two weeks for an appointment and he said come back in 3 months b/c they were not large enough to biopsy and because I am so skinny he feared he would puncture a lung. Why would he say come back in 3 months? Btw I am 6'2 and 170 ibs

OK so today after feeling my lower armpit I have found yet another larger 3cm movable mass that appears to be yet another lymph node. It moves quite easily and is very long and thin. It may have been there before as it takes quite a bit of feeling around to find. Is it normal to find lumps, bumps, and lymph nodes if you press hard enough and search enough in your body? And should it be a concern unless it is easily noticeable or protruding in some way?

OK doctor now I am very concerned, In the deep area of my armpits and after a lot of feeling around in those areas I have encountered yet another few movable hard masses. The one in my right arm pit is about 3cm by 4cm and has a very odd shape and is very movable. On the left I have found one that is also hard and movable and about 3 or 4 cm with smaller ones nearby. I am now very very concerned, these nodes feel quite odd. Especially since you stated that it is not normal to find these lumps and bumps. What could cause this? if the lymphoma is this widespread wouldn't it have shown indicators in my blood tests by now?

Thanks for the timely reply. Because I have so many swollen nodes in my neck and armpits(both sides) and no symptoms would your personal suspicion of lymphoma be quite low due to the fact that my blood tests have been fine thus far? Also if it was a lymphoma in my neck and armpits and presenting in so many swollen nodes wouldn't I be feeling a little bit sick or tired?

So you wouldn't classify widespread persistent lymphadenopathy in my neck and armpits with some masses over 3cm and irregularly shaped as concerning? Is this common in anything besides lymphoma?

Well you just said this is not concerning like 2 minutes ago? I don't understand?

Ok we both know it concerns me, the thing is my surgeon didn't find these nodes upon exam, if he would have found them and said they were benign I wouldn't be concerned either. But he didnt , and my question for you is if this was lymphoma in all these nodes in both armpits and neck wouldnt something have indicated it in my blood test? Also would these nodes show up in a chest xray?

I'm sorry as you know I am very concerned. You are a very patient and helpful doctor. In lymphomas do all nodes present as abnormal or concerning if it is widespread or can some appear benign and some malignant? I also occasionally pluck my armpit hairs because I am a swimmer, sometimes this causes ingrown hairs that I've had to pull out, could this cause such lymphadenopathy in my armpit? Or would it likely go away with time?

Thanks again doctor 1. surgeon has dismissed me for 3 months after exam 2. Widespread persistent lymphadenopathy with no other symptoms 3. Normal blood tests 4. All nodes are movable and don't appear to be growing larger 5. Largest nodes are in armpit and are hard to find generally(not found in exam by surgeon) over 3cm, most other nodes are 1 cm or less If you were my doctor and I presented you with this info what would your level of concern be on a scale of 1 to 10?

I understand that and appreciate that but I think you are missing what I am asking. If you were my doctor and I presented you with 1. surgeon has dismissed me for 3 months after exam 2. Widespread persistent lymphadenopathy with no other symptoms 3. Normal blood tests  4. All nodes are movable and don't appear to be growing larger  5. Largest nodes are in armpit and are hard to find generally(not found in exam by surgeon) over 3cm, most other nodes are 1 cm or less Would you suspect a lymphoma? Or something else based on that info?