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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Looking for second opinion not same ENT if you just

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Dr. Riddhi Shah

ENT Specialist

Practicing since :2008

Answered : 515 Questions

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Posted on Sun, 27 Jan 2019 in Ear, Nose and Throat Problems
Question: Looking for second opinion not same ENT if you just answered


Dr I had an MRI of soft tissue of neck...I have been having some ear ache and left side front ache very mild. It said normal but 10 mm lymph node adjacent to left submandibular.

My dr says normal...is normal up to 10 mm or 15 mm in this area? Is one lymph node noted this size likely infection or what? I worry if its at the upper limit it could be cancer getting bigger...Dr said glands felt okay...he is an ENT. Should I have any other testing...I have no weight loss....no energy loss...no cough...etc
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Follow up: Dr. Riddhi Shah 2 minutes later
I tried too attach page two no luck, and I want to really understand what it says not just normal.
doctor
Answered by Dr. Riddhi Shah 1 hour later
Brief Answer:
Need more details

Detailed Answer:
Hi,

Thank you for posting your query on Ask A Doctor service.

I have gone through your query and can understand your concern.

The reports which you have sent are not properly uploading completely.I would request you to again upload the reports ,so that whole page can be uploaded. You can also send the reports at YYYY@YYYY and address it to my name: Dr Riddhi Shah

Another thing,I want to ask you is :
1.)whether you feel any pain over the site where lymph node is mildly enlarged,
2.)is there any hardness over that neck region,
3.)is that lymph node palpable to you,
4.)is that lymph node XXXXXXX
5.)do you have any tobacco/alcohol addiction,
6.)did you suffered from cold/throat pain, few days back?

Awaiting for your reply.

Thanks
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Riddhi Shah 14 hours later
I have re uploaded the reports.

1. No pain over site however mild intermittent ear and sometimes front neck discomfort on same side as left submandibular
2 & 3 No hardness and my ENT felt and said all felt normal...so I presume not palpable.
4. I believe so
5. I quit smoking at 42 after 16 pack years...stopped 27 years ago. 10-12 wines per week.
6. The MRI was done 11-8-18...and physical exam twice...11-7-18 and again 1-7-19.

My ENT says completely normal but why the intermittent discomfort...same side...unrelated? I think I'm most concerned by the unknown...I don't really understand the report...one 10 mm node adjacent near or in submandibular...is XXXXXXX normal size 10 mm or 15 mm? I read different things. One just one maximum 10 mm node be cause for any concern? Does cancer generally express its self this way or would there be more nodes effected? If its at the XXXXXXX size how do we know its not going to get larger? Do you believe I'm okay given the information and results or would you be apt to run other tests if it were yourself? If not would you do a follow you do a follow up MRI now or when? Thanks
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Follow up: Dr. Riddhi Shah 5 hours later
ENT because of my worry is going to have a needle biopsy done to rule out.

If it were unfortunately cancer would it likely be primary as in Non Hodgkins or lymphoma?

And secondly if it were from another primary site wouldn't Likely already have symptoms or feel sick? Weight loss, energy, naususa, cough, lumps, etc. ??? I have none of this or other symptoms. Thanks.
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Follow up: Dr. Riddhi Shah 23 minutes later
and finally if the cancer was in the lymph node and not primary what are the most likely primary sites.
doctor
Answered by Dr. Riddhi Shah 8 hours later
Brief Answer:
Please see the answer

Detailed Answer:
Hi, thank you for your reply.

I have gone through your report.

Lymph node enlargement of 10 mm is considered normal in routine.The morphology of lymph node seems to be reactive or physiologic.Reactive means,that it would have occurred as a result if you had any infection/inflammation in head /ear/nose/throat /face in the past.Sometimes lymph node get enlarged reactively and they may not resume their original size,even though the primary infection has gone.
If the lymph node enlargement would be a cancerous,then in the MRI, cancerous changes would have been seen in the lymph node.
Again,if you suffered from any cancer,the lymph node may feel hard,non-mobile,and gradually increase in size.

If the lymph node cancer is secondary,then primary sites should be in the head or neck.In your MRI,no abnormality is
seen in those sites.

In case of primary lymph node carcinoma, lymph node enlargement may be at other sites of body like Axillary (arm pit), abdominal,pelvic,groin,
spleen,etc.Your blood picture will be changed in that case.And yes,you will feel symptoms like weakness, weight loss,fever,sweats,etc.You don't have any such symptoms.

Still if you worry,then a 1.)needle biopsy and a 2.)laboratory test of complete blood picture with peripheral smear and ESR ,and an 3.)Ultrasound examination of abdominal and pelvic region would be helpful to rule out lymph node cancer.

You are suffering from intermittent ear and neck pain.One possibility might be neuralgic pain.Consult your ENT to check for that.In such cases,medicines like Carbamazepine/Gabapentin,etc are helpful.

If the swelling of lymph node gets enlarged from before,gets harder and non-mobile,gets painful,etc then it would be advisable to again go for screening test with Ultrasonography and needle biopsy of neck.

Hope this answers your question.
Take care.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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