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Noticed large swelling on left side of child's neck. Lost weight, dizziness and headache. Is it a form of lymphoma?

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Oncologist, Surgical
Practicing since : 2004
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Four days ago I noticed a large swelling on the left side of my daughter's neck. I thought it might be her parotid gland. It is hard, does not move when she swallows, but is painful to be palpitated. (It was later measured at 2.8 x 1.0 cm.) Yesterday, I took her to her doctor who ordered an immediate echocardiogram. The report is as follows, but please understand that it has been sent through Google Translate, so the English is a bit rough: "It explores the soft tissues of the neck to the left of the midline, in retro parotid region identifying multiple nodules regular oval well-defined contours that reach diameters of up to 2.8 x 1.0 cm with Doppler flow show abundant inside. On the same side there are numerous nodules of meno [less] size occupying ye submental submandibular chains whether as XXXXXXX jugular chains II-III and V. On the right side are present multiple lymph nodes of smaller size to those described occupying the regions listed above, can measure up to 1 cm in diameter. Diameters body retains normal thyroid homogeneous echogenicity. Needlestick suggest histopathological study of left atrial node retro. Bilateral lymphatic adenitis, more marked on left side." Her doctor said it was not her thyroid and is sending her to an oncologist for further testing on Monday. Additional symptoms include: She has lost weight in the last 8 months. She is tired and frequently complains of dizziness, headaches and severe stomach aches. (I have ruled out lactos and gluten intolerance as causative factors for the stomach aches.) She has not had noticeably high temps, but yesterday and today I took her temps and they were a bit low: 98.1 and 97.6. I have not noticed night sweats per se, but have been surprised that she wants only one thin blanket at night, complaining of being "too hot" when the rest of us use several blankets. I need more information. I am not in the US and am not fluent in the local language nor do they speak English. Is it possible she has some form of lymphoma? What is the significance of all these reported nodules on her neck? What does the report mean? Would her doctor send her to see an oncologist for anything else besides a suspicion of cancer? What sort of cancer?
Does my 8 yr. old have some form of lymphoma?
Posted Mon, 11 Nov 2013 in Cancer
Answered by Dr. Krishna Kiran Kannepalli 1 hour later
Brief Answer:
Lymphoma is a possibility

Detailed Answer:
Hi. Thanks for the query. You have given an elaborate description and it is highly appreciated. Lymphoma is a definite possibility. Please check ifshe has lumps in the axilla and groin too. The best course of action would be to do a lymph node biopsy as needle testswont give adequate information. Based on the biopsy report of the lymph node, further course of action can be planned. At this age, some viral infections also present similarly and the biopsy tissue can be sent for these tests too. You can discuss them with your oncologist. Please let us know the results of the tests. We will be happy to answer any further queries.
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Follow-up: Noticed large swelling on left side of child's neck. Lost weight, dizziness and headache. Is it a form of lymphoma? 8 hours later
OK, I tried to write a follow up question but did not receive any indication it went through. I'll try again. :)

The doctor may be planning on doing a biopsy because I was told to bring her in in a fasting state.

As suggested, I did check her arm pits. I think I may have found some on the right side, but am not sure as I do not know where to look or how "deep" to feel. I did find some hard lumps, a big larger than a kidney bean, in her groin. Is that the size they are normally there on an 8 year old?

My real concern is for the biopsy. Several sites stated the danger of damage to nearby nerves, suggesting such a biopsy be done only by a doctor who has done lots of them in that area. Should I make this request? I certainly do not want any damage to a facial nerve.

Also, in case she does have a biopsy on Monday, should she be taking ibuprofen?? Or is it safer than aspirin with regards to clotting factors? Thanks in advance for all your help! This is a rather scary situation for us.
Answered by Dr. Krishna Kiran Kannepalli 15 hours later
Brief Answer:
Biopsy is safe. ibuprofen can be continued.

Detailed Answer:

Lymph node biopsy is generally done by a surgeon or a surgical oncologist. As she is 8 years old it is better to do it under general anaesthesia. There is no risk of damage to nerves if it is done carefully. We do about 30 a month. Never had any issues. Ibuprofen can be taken safely. It does not derange clotting factors. The best site for the biopsy will be determined by the treating doctor. It is difficult to say without seeing the patient. Lower neck nodes if significant are the best. Leave it to your oncologist.
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Follow-up: Noticed large swelling on left side of child's neck. Lost weight, dizziness and headache. Is it a form of lymphoma? 2 days later
Thank you so much for all your help. The doctor wants to try her for 15 days on a broad-spectrum, sepholosporin antibiotic before doing a biopsy. I sure hope this will address, not just the hard lymph nodes, but the headaches, dizziness, stomach ache, itchiness, pain, etc. I am not entirely satisfied with his extremely quick perusal. The other doctor spent more time on exam then this one did. I guess my concern is over how well he was able to determine it is only infection (1. Can you truly feel swollen groin nodes through two layers of heavy cloth?) and if it is not an infection, is a 15 day delay dangerous? Thank you so much for all your help!
Answered by Dr. Krishna Kiran Kannepalli 1 hour later
Brief Answer:
15 days is reasonable

Detailed Answer:
Waiting for 15 days is reasonable. But if lymph nodes persist beyond that period, biopsy should not be delayed further
Above answer was peer-reviewed by
Follow-up: Noticed large swelling on left side of child's neck. Lost weight, dizziness and headache. Is it a form of lymphoma? 9 minutes later
Thank you so much for all your help. Last question: he prescribed for her 250 mg. of a liquid suspension sepholosporin antibiotic. The problem is, it tasted so bad that she threw up. He wants her to take 250 mg., twice a day for 15 days. Coming from the US, that seems excessive to me. Wouldn't it be better to get the titer up and take, say 500 mg. for five days? I tasted the liquid suspension medicine as well and now understand why she threw up. I will be switching her to tablets. Just want a second opinion on the amount and the duration. (You are not going against the doctor to share this info with me. In this country, you do not need a prescription for antibiotics. Just walk into a farmacia, tell them what you need and what dosage and they give it to you.)
Answered by Dr. Krishna Kiran Kannepalli 5 days later
Brief Answer:
Cephalosporin is broad name...

Detailed Answer:

Apologies for the late reply...

Cephalosporin is a class of drug which has broad spectrum antibiotic. I am not sure which among various cephalosporin is prescribed to her. Perhaps it is cefuroxime.

I understand that your daughter is unable to tolerate the medication. However 250mg twice daily for 15 days is not equivalent to 500mg for 5 days; 5 days of 500mg wouldn't cover for 15 days. Therefore it is not right choice to hike the dosage.

If nausea and vomiting is severe, alternative choices in this circumstances are:
1. Try an alternative brand with a different flavor - if that's available. Your pharmacist can help you here.
2. Some children are able to tolerate oral tablets/capsule better. You may try this preparation instead of suspension.
3. Use an antiemetic syrup along with antibiotic to control her vomiting.
4. If none of the options are feasible, you can discuss with her treating doctor to stop this antibiotic.

Above answer was peer-reviewed by
Follow-up: Noticed large swelling on left side of child's neck. Lost weight, dizziness and headache. Is it a form of lymphoma? 19 hours later
Thank you so much for the detailed answer. Today, I took my daughter back to the doctor who originally ordered an ultrasound of her neck. She is getting worse. She has not improved with time nor on the antibiotic. He called in another doctor to consult and then they called a third doctor to get her in for a more extensive and immediate echocardiogram of her neck, armpits, abdomen and groin.

I have put through Google Translate the doctor's report of the echocardiogram. My question is: Would you please put it in plain English and in laymen's terms for me? I need to know what the report means and what the possible health ramifications are. Are we still looking at cancer? Or something else and if so, what? I have to largely educate myself via the internet due to language difficulties, so I really appreciate any information you can share with me.

Here is the report as sent through Google Translate:

Exploration demonstrated in left neck, presence of multiple (11) hypoechoic nodular lesions ganlionar [ganglionar?] origin, the largest size is 29, 29, 16 and 9 mm. (2.9, 2.9, 1.6 and 0.9 cm.) At level 5, the Doppler ilio identified, the flow in the second dominant lesion increased slightly, to moderately sensitive compression. The lesions described are mainly located in level three and five.

Right side of the neck Exploration without obvious pathology data. Thyroid Gland unscathed. Vascular structures unchanged.

Region right axillary lymph node shows two images of 12 x 8.5, (1.2 X .85 cent.) 14.6 x 8.4 mm. (1.46 X .84 cent.) No flow increase, hilum identified.

Region left axillary nodal image demonstrates solitary 12.7 x 6.3 mm. (1.27 X .63 cent.), Similar behavior to the contralateral.

ID: pictures in probable relation to reactive lymph node hyperplasia. Control suggests post treatment.

Liver size and shape normal homogeneous echotexture. Gallbladder no pathology data. Normal caliber biliary tract. Choledocus of 2.3 mm. Pancreas without pathological data of interest. Free retroperitoneum. Left and right kidney unchanged. Normal spleen. Flanks and free iliac fossae.

Anteflexion Utero in regular and defined contours, homogeneous echotexture. The endometrium is Delgado regularly. Free Cavity. Their diameters maximums are: 20 (L) mm, 8.8 (AP) mm, 19.5 (T) mm.

Normal-appearing cervix. Free fornix. Left and right ovary shape, size Normal echostructure ye. Thin walled bladder, adequate capacity, without solids therein. Free ureterovesical Union.

Exploration in right inguinal region shows the presence of three images ganglion the largest size of 4 mm je sleep less [minor axis?]. Three images left inguinal lymph node the size of 4mm high je sleep less [minor axis?], typical morphology.

Any information you can provide me on this will be greatly appreciated!

Answered by Dr. Krishna Kiran Kannepalli 36 hours later
Brief Answer:
she has generalised lymphadenopathy

Detailed Answer:
From the ultrasound it is apparent the child has generalised lymphadenopathy. The management plan still remains the same. If there is no significant decrease in size of the nodes after a course of antibiotics, biopsy is warranted. All other investigations are akin to beating around the Bush. I hope I have ansewered your query.
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