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Suggest Treatment For Swollen Occipital Lymph Node And Scalp Seborrhea
Question: I'm a 56 year old male in good health. About 6 weeks ago, I noticed a small knot (about the size of a pea) in the back of my neck, just below the hairline and about 2 inches over from my earlobe. The knot has not noticeably changed in size (though may be slightly smaller than when I first noticed it). I have no symptoms such as fatigue, unexplained weight loss, unusual itching, night sweats or fever. During this same period, I have struggled with my allergies and sinuses and have had a flare of my scalp seborrhea. The knot is not rock hard, but feels somewhat rubbery. Some providers who have felt it say it moves somewhat, others don't feel they can move it much. It is not tender to the touch, but after it's been palpated, it feels a bit sore. I go for an ultrasound Friday, but am quite anxious about the knot. Could this simply be a residual from either the allergy/sinus flare and/or the seborrhea flare, or is it more likely lymphoma due to the questionable ability to move the knot? I would appreciate any information.
Brief Answer:
Sebaceous cyst or a reactive lymph node.
Detailed Answer:
Hi.
Thanks for your query and an elucidate history.
To recapitulate salient points: Male/56 - small knot - pea sized 6 weeks - back of neck as explained - same size - not rock hard, feels rubbery -not tender - slightly XXXXXXX - no other symptoms - except flare up of scalp seborrhea and allergy/sinus flare up - ultrasound on Friday - anxious as whether residual from flare f allergy/sinus/seborrhea or lymphoma.
First of all, the differential diagnosis is sebaceous cyst or a lymph node.
This can be an enlarged lymph node in the occipital site and the obvious reason of flare up of scalp seborrhea can explain this.
Ultrasonography will help distinguish between the cyst and the node.
Please insist for FNAC (fine needle aspiration cytology) if this turns to be a lymph node on ultrasound.
This will confirm what it is and you will be assured of the diagnosis.
I hope this answers your query, helps you to get the proper diagnosis and treatment and most of all relieves stress and anxiety.
Please feel free to ask for further relevant queries if you need to or if you feel that there is a gap of communication.
Sebaceous cyst or a reactive lymph node.
Detailed Answer:
Hi.
Thanks for your query and an elucidate history.
To recapitulate salient points: Male/56 - small knot - pea sized 6 weeks - back of neck as explained - same size - not rock hard, feels rubbery -not tender - slightly XXXXXXX - no other symptoms - except flare up of scalp seborrhea and allergy/sinus flare up - ultrasound on Friday - anxious as whether residual from flare f allergy/sinus/seborrhea or lymphoma.
First of all, the differential diagnosis is sebaceous cyst or a lymph node.
This can be an enlarged lymph node in the occipital site and the obvious reason of flare up of scalp seborrhea can explain this.
Ultrasonography will help distinguish between the cyst and the node.
Please insist for FNAC (fine needle aspiration cytology) if this turns to be a lymph node on ultrasound.
This will confirm what it is and you will be assured of the diagnosis.
I hope this answers your query, helps you to get the proper diagnosis and treatment and most of all relieves stress and anxiety.
Please feel free to ask for further relevant queries if you need to or if you feel that there is a gap of communication.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for the reply. It was indeed helpful. My concern for lymphoma was based on the rubbery feel and the fact that it was relatively immovable, but apparently these characteristics do not rule out either a reactive lymph node or sebaceous cyst?
I would mention that my doctor initially thought the knot could simply be a knotted muscle in my neck and applied moderate pressure to try to relieve the knot (which obviously did not work). However, for the remainder of the day, my neck was quite sore around the knot where he applied the pressure. I'm not sure if this adds anything to the diagnostic consideration?
I do tend to frequently get knots in the muscles in my back and shoulders and my wife has commented that the knot in question in my neck does not feel any different from those she feels in my back and shoulders. Could this possibly account for the knot in my neck?
Thank you so much for your time.
I would mention that my doctor initially thought the knot could simply be a knotted muscle in my neck and applied moderate pressure to try to relieve the knot (which obviously did not work). However, for the remainder of the day, my neck was quite sore around the knot where he applied the pressure. I'm not sure if this adds anything to the diagnostic consideration?
I do tend to frequently get knots in the muscles in my back and shoulders and my wife has commented that the knot in question in my neck does not feel any different from those she feels in my back and shoulders. Could this possibly account for the knot in my neck?
Thank you so much for your time.
Brief Answer:
Less likely to be a muscle knot.
Detailed Answer:
Thanks fr your feedback and some additions like knots in muscles.
Your concern about a pea sized knot as lymphoma just because it is rubbery does not rule out reactive lymph node or sebaceous cyst.
Any knot in any muscle is very painful, limits the movements of the part it supports and does not last for 6 weeks. The pain you got due to moderate pressure might be muscular and may not be due to muscle knot.
The muscle knot will become fibrotic and firm to hard in 6 weeks.
Hence less likely to be muscle knot.
Ultrasonography and FNAC or biopsy will prove what it is.
Less likely to be a muscle knot.
Detailed Answer:
Thanks fr your feedback and some additions like knots in muscles.
Your concern about a pea sized knot as lymphoma just because it is rubbery does not rule out reactive lymph node or sebaceous cyst.
Any knot in any muscle is very painful, limits the movements of the part it supports and does not last for 6 weeks. The pain you got due to moderate pressure might be muscular and may not be due to muscle knot.
The muscle knot will become fibrotic and firm to hard in 6 weeks.
Hence less likely to be muscle knot.
Ultrasonography and FNAC or biopsy will prove what it is.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you, sir. Final question...the fact that it is relatively immovable was somewhat concerning to me based on what I understand about malignancies. Is this cause for concern?
Brief Answer:
Malignancy or not malignancy is always confirmed by FNAC/biopsy.
Detailed Answer:
You are most welcome!
The area you mentioned is " just below the hairline and about 2 inches over from my earlobe"
If you feel this area particularly in a bending position, you will understand the skin is also relatively immobile due to tightness. Hence whatever the lesion may be, it will be perceived as relatively immobile.
Again to stress - Ultrasound and guided FNAC helps to clear the doubts and reduce the stress and/or anxiety.
Malignancy or not malignancy is always confirmed by FNAC/biopsy.
Detailed Answer:
You are most welcome!
The area you mentioned is " just below the hairline and about 2 inches over from my earlobe"
If you feel this area particularly in a bending position, you will understand the skin is also relatively immobile due to tightness. Hence whatever the lesion may be, it will be perceived as relatively immobile.
Again to stress - Ultrasound and guided FNAC helps to clear the doubts and reduce the stress and/or anxiety.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. Chandrakant...I had the ultrasound which revealed several lymph nodes (rather than just one) in the occipital region, the largest being about 1 cm and, obviously, the others smaller than 1 cm. The radiologist and internist believe this to be reactive adenopathy resulting from the seborrhea and have advised waiting another month and then repeating the ultrasound if the nodes are still present. He points to the absence of other symptoms, such as night sweats, unexplained weight loss, etc., as reasons to wait. I have some additional questions at this time: 1. Does this seem to be a reasonable strategy 2. Does the fact that there is more than a single lymph node change your diagnostic impression at all? 3. Does the fact that they are all 1 cm or less have any significance? 4. Does the fact that they've not increased in size at all over about 6 weeks have any significance? Thanks again for your assistance.
Brief Answer:
As detailed below.
Detailed Answer:
Noted your feedback, report and an opinion of your Radiologist and Internist well.
To answer your queries:
1. Does this seem to be a reasonable strategy
>The strategy is correct. All the nodes are sub-centimeter the largest one being cm. The Radiologist does watch for whether the internal structure is disturbed or not. He must have seen no disturbance related to the interior of nodes. Wait and watch can be done.
2. Does the fact that there is more than a single lymph node change your diagnostic impression at all?
> Not really, since the count on actual palpation and ultrasonography and actual surgery differ. Secondly, numbers may not have much value in deciding the cause.
3. Does the fact that they are all 1 cm or less have any significance?
> The sizes of less than 1 cm that is sub-centimeter are usually due to reactive hyperplasia. Hence not of much significance.
4. Does the fact that they've not increased in size at all over about 6 weeks have any significance?
> They are stationary means there is no active disease that causes them to enlarge.
If you still have the anxiety, you may please request/insist for FNAC.
I hope this answer helps you.
As detailed below.
Detailed Answer:
Noted your feedback, report and an opinion of your Radiologist and Internist well.
To answer your queries:
1. Does this seem to be a reasonable strategy
>The strategy is correct. All the nodes are sub-centimeter the largest one being cm. The Radiologist does watch for whether the internal structure is disturbed or not. He must have seen no disturbance related to the interior of nodes. Wait and watch can be done.
2. Does the fact that there is more than a single lymph node change your diagnostic impression at all?
> Not really, since the count on actual palpation and ultrasonography and actual surgery differ. Secondly, numbers may not have much value in deciding the cause.
3. Does the fact that they are all 1 cm or less have any significance?
> The sizes of less than 1 cm that is sub-centimeter are usually due to reactive hyperplasia. Hence not of much significance.
4. Does the fact that they've not increased in size at all over about 6 weeks have any significance?
> They are stationary means there is no active disease that causes them to enlarge.
If you still have the anxiety, you may please request/insist for FNAC.
I hope this answer helps you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks again for your thorough response. You are correct that I do have some anxiety (I think most people don't like finding lumps where they don't belong!) but your responses are educating me and helping to allay the anxiety. If I may, a couple more questions I didn't have the opportunity to ask my doctor. 1. Is it accurate that cancers are rarely the cause of enlarged lymph nodes in occipital area? 2. I'm curious as to how the lymph nodes less than 1 cm can be felt. If they are considered normal below 1 cm, how is it that they can be palpated? What makes them different from "normal" lymph nodes that typically can't be felt in this area?
Thank you again for your responses. They have truly helped me deal better with this rather stressful situation.
Thank you again for your responses. They have truly helped me deal better with this rather stressful situation.
Brief Answer:
As detailed below.
Detailed Answer:
Thanks for your appreciation.
You are absolutely right in saying so, the anxiety rules once someone finds something unusual and the internet, friends, family so-called well wishers adds to the confusion and the anxiety.
Please go ahead, I shall be happy to assist you further till you want.
To answer your further queries:
1. Is it accurate that cancers are rarely the cause of enlarged lymph nodes in occipital area?
> Yes, this point is also very important. The lymphatic channels have a typical drainage system, they drain the area from which they receive the lymphatic channels. Since the area drained by the occipital nodes does not have much cancers, they are very rarely involved in spread of cancer.
2. I'm curious as to how the lymph nodes less than 1 cm can be felt. If they are considered normal below 1 cm, how is it that they can be palpated?
> Palpation of the lymph nodes or for that matter any mass/swelling depends upon the depth at which they are placed.
They are not considered normal, they go into change of reactive hyperplasia and hence get enlarged and remain palpable. Smaller nodes than this can also be palpated if they are superficial.
What makes them different from "normal" lymph nodes that typically can't be felt in this area?
> Deep seated lymph nodes can not be palpated in spite they are enlarged. There are other tissues in the same area that can apparently make them hidden.
I hope that these answers help to clear your doubt further.
As detailed below.
Detailed Answer:
Thanks for your appreciation.
You are absolutely right in saying so, the anxiety rules once someone finds something unusual and the internet, friends, family so-called well wishers adds to the confusion and the anxiety.
Please go ahead, I shall be happy to assist you further till you want.
To answer your further queries:
1. Is it accurate that cancers are rarely the cause of enlarged lymph nodes in occipital area?
> Yes, this point is also very important. The lymphatic channels have a typical drainage system, they drain the area from which they receive the lymphatic channels. Since the area drained by the occipital nodes does not have much cancers, they are very rarely involved in spread of cancer.
2. I'm curious as to how the lymph nodes less than 1 cm can be felt. If they are considered normal below 1 cm, how is it that they can be palpated?
> Palpation of the lymph nodes or for that matter any mass/swelling depends upon the depth at which they are placed.
They are not considered normal, they go into change of reactive hyperplasia and hence get enlarged and remain palpable. Smaller nodes than this can also be palpated if they are superficial.
What makes them different from "normal" lymph nodes that typically can't be felt in this area?
> Deep seated lymph nodes can not be palpated in spite they are enlarged. There are other tissues in the same area that can apparently make them hidden.
I hope that these answers help to clear your doubt further.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I do appreciate your patience with me and you have indeed helped to clear doubt/concerns. Since I have one question remaining, I thought I'd share the ultrasound report (cut/pasted below), which appears to be generally good news, although I don't speak radiology. Also, one final question...how long might it take for the lymph nodes to return to normal size, particularly given that seborrhea is a chronic condition and I do have periodic flares. Even between flares, I tend to have dandruff and scaly plaques. I've read that lymph nodes may swell quickly, but be slow to return to normal.
Ultrasound Soft Tissue
COMPARISON: None available.
TECHNIQUE: Real-time gray-scale and Color doppler sonographic evaluation of the left posterior scalp.
FINDINGS: Multiple hypoechoic masses with central fatty hilum and vascular pedicle likely represent suboccipital lymph nodes. The largest measures 1.0 x 0.4 x 0.8 cm. There is normal morphology. Thickness of approximately 0.2 cm.
IMPRESSION:
Multiple conspicuous lymph nodes within the left suboccipital region which may represent reactive adenopathy in the appropriate clinical setting of reported seborrheic dermatitis. Recommend repeat sonogram if lymph nodes fail to resolve or with continued pain at site. Consider dermatologic consultation if clinically indicated.
Again, thank you for your help. You are truly knowledgeable and most kind to take the time to respond to my many questions.
Ultrasound Soft Tissue
COMPARISON: None available.
TECHNIQUE: Real-time gray-scale and Color doppler sonographic evaluation of the left posterior scalp.
FINDINGS: Multiple hypoechoic masses with central fatty hilum and vascular pedicle likely represent suboccipital lymph nodes. The largest measures 1.0 x 0.4 x 0.8 cm. There is normal morphology. Thickness of approximately 0.2 cm.
IMPRESSION:
Multiple conspicuous lymph nodes within the left suboccipital region which may represent reactive adenopathy in the appropriate clinical setting of reported seborrheic dermatitis. Recommend repeat sonogram if lymph nodes fail to resolve or with continued pain at site. Consider dermatologic consultation if clinically indicated.
Again, thank you for your help. You are truly knowledgeable and most kind to take the time to respond to my many questions.
Brief Answer:
Central fatty hilum is maintained.
Detailed Answer:
You are most welcome.
Very nice to interact you.
Returning of hte nodes to normal size is very variable as there is a cause in you case, the seborrhoic dermatitis, dandruf and scaling and periodic flare ups.
Yes, they swell so quickly but take variable time to regress back or may not in many cases as there is hyperplasia.
The ultrasonography report as we discussed above is classically notifies about the
''central fatty hilum'' - this is mentioned in reactive hyperplasia but lost in cancer.
This is why your Doctors are sure about the nature and cause of enlargement.
Since there is a cause, I would request you to consult a Dermatologist for the proper ''treatment of the cause'' and if treated properly the nodes problems will automatically vanish.
I hope this answer helps you.
Please feel free to communicate further if you feel that there is a gap of communication.
Central fatty hilum is maintained.
Detailed Answer:
You are most welcome.
Very nice to interact you.
Returning of hte nodes to normal size is very variable as there is a cause in you case, the seborrhoic dermatitis, dandruf and scaling and periodic flare ups.
Yes, they swell so quickly but take variable time to regress back or may not in many cases as there is hyperplasia.
The ultrasonography report as we discussed above is classically notifies about the
''central fatty hilum'' - this is mentioned in reactive hyperplasia but lost in cancer.
This is why your Doctors are sure about the nature and cause of enlargement.
Since there is a cause, I would request you to consult a Dermatologist for the proper ''treatment of the cause'' and if treated properly the nodes problems will automatically vanish.
I hope this answer helps you.
Please feel free to communicate further if you feel that there is a gap of communication.
Note: For further inquiries on surgery procedure and its risks or complications book an appointment now
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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