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Suggest Treatment For Generalized Lymphadenopathy
Question: Hello.
I refuse to just stand by in case of Indolent Lymphoma!
Here is where I am at:
Male, 53, non smoker.
-3-4 years ago I sarted noticing many Sebhorreic K in my back, in the hundreds, all over and continue to increasy in my chest and stomach. Pseudo Lesser trelat because the did not appear Suddenly.
-At almost the same time, I broke out a rash that persists to this day, it's on my neck and arms, for 1 year I could only cotrol the itch with topical hidrocort 1% cream. Dermatologist put me on Cetirizine + ranitidie and that controls the itch but I can not suspend it. Been on that regimen for over a year.
-About a year ago, started noticing swolen lymph nodes, supraclavicular and jugulodigastric; doc, sent me to PET Scan and ALL came back OK,.... No cancer activity.
-6 mo. ago.. doc., did a byopsy /removed supraclavicular and it came back as UNSPECIFIC HYPERPLASIA. Doc. said it could be E. Barr syndrome and gave me pain medicine since the started to hurt.
-3 mo ago I noticed my right Popliteal nodes started hurting when I drank alcohol.
NOW.... Popliteal L. always have a dull pain, Inguinal of the same side are slightly swolen, neck vessels hurt and now the same side forearm feels the same. Jugulodigastric.. of the other side remains swollen and has a dull pain.
Here is the fun part.
NO B SYMPTOMS
ALL BLOD TEST ARE OK.
Had an Ches Xray yesterday and all is ok.. except for diaphragmatica eventration that developed 2-3 year ago.. Phrenic never involvment is unknown.
Doc. mentioned indolent lymphoma.. but I refuse to remain pasive.. just whaiting.. FOR WHAT? More pain? Ignore untill blood test com back with something? The pain on my lymph nodes/vessels could be an infection .. correct... but for 4 years?
I need to do somethig?
I welcome your reply.
I refuse to just stand by in case of Indolent Lymphoma!
Here is where I am at:
Male, 53, non smoker.
-3-4 years ago I sarted noticing many Sebhorreic K in my back, in the hundreds, all over and continue to increasy in my chest and stomach. Pseudo Lesser trelat because the did not appear Suddenly.
-At almost the same time, I broke out a rash that persists to this day, it's on my neck and arms, for 1 year I could only cotrol the itch with topical hidrocort 1% cream. Dermatologist put me on Cetirizine + ranitidie and that controls the itch but I can not suspend it. Been on that regimen for over a year.
-About a year ago, started noticing swolen lymph nodes, supraclavicular and jugulodigastric; doc, sent me to PET Scan and ALL came back OK,.... No cancer activity.
-6 mo. ago.. doc., did a byopsy /removed supraclavicular and it came back as UNSPECIFIC HYPERPLASIA. Doc. said it could be E. Barr syndrome and gave me pain medicine since the started to hurt.
-3 mo ago I noticed my right Popliteal nodes started hurting when I drank alcohol.
NOW.... Popliteal L. always have a dull pain, Inguinal of the same side are slightly swolen, neck vessels hurt and now the same side forearm feels the same. Jugulodigastric.. of the other side remains swollen and has a dull pain.
Here is the fun part.
NO B SYMPTOMS
ALL BLOD TEST ARE OK.
Had an Ches Xray yesterday and all is ok.. except for diaphragmatica eventration that developed 2-3 year ago.. Phrenic never involvment is unknown.
Doc. mentioned indolent lymphoma.. but I refuse to remain pasive.. just whaiting.. FOR WHAT? More pain? Ignore untill blood test com back with something? The pain on my lymph nodes/vessels could be an infection .. correct... but for 4 years?
I need to do somethig?
I welcome your reply.
Brief Answer:
You should go for immunohistochemistry.
Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
You have generalised lymphadenopathy. Your biopsy gives non specific hyperplasia. You may have Iindolent lymphoma or reactive hyperplasia of lymphnode. However chances of reactive hyperplasia is less. Because reactive hyperplasia occurs due to infection. And it is less likely yhat you have infection without other manifestation.
You should go for lymphnode biopsy and immunohistochemistry study on that.
It will give you exact diagnosis whether it is lymphoma, reactive hyperplasia or something else. It is very specific test. You can relay on that results. Then you should take treatment accordingly.
It will help you in early diagnosis and treatment. Continue your treatment of skin problem according to your dermatologist advise.
Consult your doctor, go for IHC and take treatment accordingly.
Hope I have answered your question, if you have doubt then I will be happy to answer. Thanks for using health care magic. Wish you a very good health.
You should go for immunohistochemistry.
Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
You have generalised lymphadenopathy. Your biopsy gives non specific hyperplasia. You may have Iindolent lymphoma or reactive hyperplasia of lymphnode. However chances of reactive hyperplasia is less. Because reactive hyperplasia occurs due to infection. And it is less likely yhat you have infection without other manifestation.
You should go for lymphnode biopsy and immunohistochemistry study on that.
It will give you exact diagnosis whether it is lymphoma, reactive hyperplasia or something else. It is very specific test. You can relay on that results. Then you should take treatment accordingly.
It will help you in early diagnosis and treatment. Continue your treatment of skin problem according to your dermatologist advise.
Consult your doctor, go for IHC and take treatment accordingly.
Hope I have answered your question, if you have doubt then I will be happy to answer. Thanks for using health care magic. Wish you a very good health.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thanks Doc.
The reactive hyperplasia is a fact; whether or not it is a first stage of an evolving Lymphoma is what worries me. I am afebrile and show no other signs of infections .. and have not since YEARS ago.
Now….Since the biopsy did not return lymphoma, doctors are reticent to do another until ADDITIONAL symptoms appear.
This is why I say… What are we waiting for?
Yes, Lymphadenopathy causes pain and I am feeling it in more parts of my body every day, but taking analgesics will only mask what could be an evolving/invading Lymphoma!
Taking this in to account:
IGE is VERY high. (Don’t have the number right now but it was almost 10 times the limit)
Antinuclear Antibodies are Negative.
The rash on my neck and face, if stop medication, becomes similar to Dermatomyositis.
The pseudo Lesser Trelat.. ongoing.
Should we wait until the jugulodigastric node grows more or becomes rock solid? Or until I can’t walk because of pain in my legs to do an additional biopsy?
I have access to any lab test, is there some specific test that can point me somewhere?
I welcome your reply.
The reactive hyperplasia is a fact; whether or not it is a first stage of an evolving Lymphoma is what worries me. I am afebrile and show no other signs of infections .. and have not since YEARS ago.
Now….Since the biopsy did not return lymphoma, doctors are reticent to do another until ADDITIONAL symptoms appear.
This is why I say… What are we waiting for?
Yes, Lymphadenopathy causes pain and I am feeling it in more parts of my body every day, but taking analgesics will only mask what could be an evolving/invading Lymphoma!
Taking this in to account:
IGE is VERY high. (Don’t have the number right now but it was almost 10 times the limit)
Antinuclear Antibodies are Negative.
The rash on my neck and face, if stop medication, becomes similar to Dermatomyositis.
The pseudo Lesser Trelat.. ongoing.
Should we wait until the jugulodigastric node grows more or becomes rock solid? Or until I can’t walk because of pain in my legs to do an additional biopsy?
I have access to any lab test, is there some specific test that can point me somewhere?
I welcome your reply.
Brief Answer:
No need to wait.
Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
No need to wait till disease spread. You should not wait till your lymphnode increased in size or it becomes rock hard.
Go for biopsy and immunohistochemistry study on that. It will clear all doubts whether it is lymphoma or reactive hyperplasia. You should go for immunohistochemistry study. Consult your doctor and plan accordingly.
Hope I have answered your question, if you have doubt then I will be happy to answer. Thanks for using health care magic. Wish you a very good health.
No need to wait.
Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
No need to wait till disease spread. You should not wait till your lymphnode increased in size or it becomes rock hard.
Go for biopsy and immunohistochemistry study on that. It will clear all doubts whether it is lymphoma or reactive hyperplasia. You should go for immunohistochemistry study. Consult your doctor and plan accordingly.
Hope I have answered your question, if you have doubt then I will be happy to answer. Thanks for using health care magic. Wish you a very good health.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
OK Doc..
Pleas feel free to be more technical, I am a healthcare professional and understand the jargon.
Yesterday I got a neck ultrasound done... and... YES, the jugulodigastric node is swolen to 2.2 cm, however, the radiologist opined that taking in to account the oval shape, and it's hilium, he does not recommend the byopsy.
The ultrasound on the popliteal node was inconclusive.
So.... I was recommended back TO SQUARE ONE! Whait!
Questions:
1.- Can nodal displasia begin as hiperplasia? Or does it start out directly as displasia.
2.-Considering ALL the other factors/manifestations I have mentioned, do you agree I should stand back and wait? Or, should I continue in my quest?
3.- If I should continue... where/what should I look?
I welcome your reply.
XXXXXX
Pleas feel free to be more technical, I am a healthcare professional and understand the jargon.
Yesterday I got a neck ultrasound done... and... YES, the jugulodigastric node is swolen to 2.2 cm, however, the radiologist opined that taking in to account the oval shape, and it's hilium, he does not recommend the byopsy.
The ultrasound on the popliteal node was inconclusive.
So.... I was recommended back TO SQUARE ONE! Whait!
Questions:
1.- Can nodal displasia begin as hiperplasia? Or does it start out directly as displasia.
2.-Considering ALL the other factors/manifestations I have mentioned, do you agree I should stand back and wait? Or, should I continue in my quest?
3.- If I should continue... where/what should I look?
I welcome your reply.
XXXXXX
Brief Answer:
You should not wait.
Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
lymphoma does not start with hyperplasia. But many a time biopsy picture of lymphoma confused with reactive hyperplasia. So that should be differentiated. Moreover if you have only reactive hyperplasia then it should be cured by antibiotics but here it is not cured. So no need to waste the time in waiting. Go for biopsy and IHC marker study. Get the exact diagnosis and start treatment accordingly.
Hope I have answered your question, if you have doubt then I will be happy to answer.
Thanks for using health care magic. Wish you a very good health.
You should not wait.
Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
lymphoma does not start with hyperplasia. But many a time biopsy picture of lymphoma confused with reactive hyperplasia. So that should be differentiated. Moreover if you have only reactive hyperplasia then it should be cured by antibiotics but here it is not cured. So no need to waste the time in waiting. Go for biopsy and IHC marker study. Get the exact diagnosis and start treatment accordingly.
Hope I have answered your question, if you have doubt then I will be happy to answer.
Thanks for using health care magic. Wish you a very good health.
Above answer was peer-reviewed by :
Dr. Yogesh D
Thanks Doc.
You got exactly to the point of the problem.
1.- I did have a biopsy/IHC this past DECEMBER-----RESULT = BENIGN LYMPHOID HIPERPLASIA
2.- Doctor is dis-regarding the additional growth of the Jugulodigastric (attached image), considering it part of the same hiperplasia.
What criteria should be followed to merit a NEW Biopsy?
Time? Size? Symptoms? Blood test? Etc.
You got exactly to the point of the problem.
1.- I did have a biopsy/IHC this past DECEMBER-----RESULT = BENIGN LYMPHOID HIPERPLASIA
2.- Doctor is dis-regarding the additional growth of the Jugulodigastric (attached image), considering it part of the same hiperplasia.
What criteria should be followed to merit a NEW Biopsy?
Time? Size? Symptoms? Blood test? Etc.
Brief Answer:
Multiple criteria are there to merit new biopsy.
Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
First of all sorry to say but there is no any attachments of image as you said in your question. So please try it again.
Now ckmes to your question, there are many criteria for new biopsy requirements.
when initial diagnosis is not sure. You have multiple enlarged lymphnode and not respofing to treatment. Size doesn't matter much in that. If you have reactive hyperplasia due to some infection then it should be cured by antibiotics.
So in your case there is some doubt in diagnosis. If you don't want to go for new biopsy then you can perform IHC study in your old biopsy also. Blocks and slides are available for further investigation.
So either you should go for new biopsy or you should go for IHC marker study on your old biopsy. But you should not wait.
Hope I have answered your question, if you have doubt then I will be happy to answer. Thanks for using health care magic. Wish you a very good health.
Multiple criteria are there to merit new biopsy.
Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
First of all sorry to say but there is no any attachments of image as you said in your question. So please try it again.
Now ckmes to your question, there are many criteria for new biopsy requirements.
when initial diagnosis is not sure. You have multiple enlarged lymphnode and not respofing to treatment. Size doesn't matter much in that. If you have reactive hyperplasia due to some infection then it should be cured by antibiotics.
So in your case there is some doubt in diagnosis. If you don't want to go for new biopsy then you can perform IHC study in your old biopsy also. Blocks and slides are available for further investigation.
So either you should go for new biopsy or you should go for IHC marker study on your old biopsy. But you should not wait.
Hope I have answered your question, if you have doubt then I will be happy to answer. Thanks for using health care magic. Wish you a very good health.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Attached 2 images.
Brief Answer:
I got the image.
Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
I got the image but the image is of your ultrasound study.
Ultrasound study can not differentiate reactive hyperplasia from indolent lymphoma conclusively. We are still remains at dilemma. whether to wait or not.
According to my advice, you should not wait.
You should go for either new biopsy or IHC study on your old biopsy. It can differentiate reactjve hyperplasia from indolent lymphoma.
Hope I have answered your question, if you have doubt then I will be happy to answer. Thanks for using health care magic. Wish you a very good health.
I got the image.
Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
I got the image but the image is of your ultrasound study.
Ultrasound study can not differentiate reactive hyperplasia from indolent lymphoma conclusively. We are still remains at dilemma. whether to wait or not.
According to my advice, you should not wait.
You should go for either new biopsy or IHC study on your old biopsy. It can differentiate reactjve hyperplasia from indolent lymphoma.
Hope I have answered your question, if you have doubt then I will be happy to answer. Thanks for using health care magic. Wish you a very good health.
Above answer was peer-reviewed by :
Dr. Yogesh D
Hello again.
Followed up with Pathologist and....NO IHC were done on sample.
They pulled the sample and will do them next week.
I asked which test would be done and the doc. office replied.. as many as the doctors deems necessary. Which brings me around to thinking... I guess the first time he deemed "0" were necessary!
I conclude at this point that morphology was conclusive enough to them as to rule out any malignancy.
"The difference between a genius and a fool..... is the end result; the difference between a stubborn patient and a hypochondriac.... could be life!"
Followed up with Pathologist and....NO IHC were done on sample.
They pulled the sample and will do them next week.
I asked which test would be done and the doc. office replied.. as many as the doctors deems necessary. Which brings me around to thinking... I guess the first time he deemed "0" were necessary!
I conclude at this point that morphology was conclusive enough to them as to rule out any malignancy.
"The difference between a genius and a fool..... is the end result; the difference between a stubborn patient and a hypochondriac.... could be life!"
Brief Answer:
Don't worry. Just wait for your results.
Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
Now don't think much about that. Just be relaxed and wait for your results.
Whatever it may be. IHC will clear everything. It will definitely give you mental peace and confirm the diagnosis. And theteIis no harm in that.
Just be relaxed. Give me follow up with your results.
Hope I have answered your question, if you have doubt then I will be happy to answer. Thanks for using health care magic. Wish you a very good health.
Don't worry. Just wait for your results.
Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
Now don't think much about that. Just be relaxed and wait for your results.
Whatever it may be. IHC will clear everything. It will definitely give you mental peace and confirm the diagnosis. And theteIis no harm in that.
Just be relaxed. Give me follow up with your results.
Hope I have answered your question, if you have doubt then I will be happy to answer. Thanks for using health care magic. Wish you a very good health.
Above answer was peer-reviewed by :
Dr. Prasad
Hello again..
Well... since I have a week until I get the IHC results....I keep reading and more questions come up.
The morphological assessment of the Pathologist read:
UNSPECIFIED REACTIVE SINUS HYPERPLASIA.
Before this he mentions follicle size, germinal centers are prominent, etc.
Should I infer that the morphology lead the Doctor to exclude malignancy, hence he did not deem necessary to preform the IHC?
Or... Is Morphology a guideline but can not CONCLUSIVELY rule out malignancy and one must ALWAYS do the IHC?
I welcome your reply.
Thanks.
Well... since I have a week until I get the IHC results....I keep reading and more questions come up.
The morphological assessment of the Pathologist read:
UNSPECIFIED REACTIVE SINUS HYPERPLASIA.
Before this he mentions follicle size, germinal centers are prominent, etc.
Should I infer that the morphology lead the Doctor to exclude malignancy, hence he did not deem necessary to preform the IHC?
Or... Is Morphology a guideline but can not CONCLUSIVELY rule out malignancy and one must ALWAYS do the IHC?
I welcome your reply.
Thanks.
Brief Answer:
It can not rule out malignancy always.
Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
Morphological guidelines is there but it can not rule out malignancy always. Specially early cases. Sometimes it is very difficult to differentiate lymphoma from reactive hyperplasia. So you may havd either of them.
Don't worry much and feel free to ask mr anytimes. Thanks for using health care magic.
Wish you a very good health.
It can not rule out malignancy always.
Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
Morphological guidelines is there but it can not rule out malignancy always. Specially early cases. Sometimes it is very difficult to differentiate lymphoma from reactive hyperplasia. So you may havd either of them.
Don't worry much and feel free to ask mr anytimes. Thanks for using health care magic.
Wish you a very good health.
Note: Do you have more questions on diagnosis or treatment of blood disorders? Ask An Expert/ Specialist Now
Above answer was peer-reviewed by :
Dr. Prasad
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