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Question: Hi. About three weeks ago I noticed a hard nodule on my neck beneath my left jaw. It is firm with no pain at all. Although I had not been sick, I didn't want to panic thinking lymph nodes swell for a variety of reasons, so I decided to wait. Finally, this past Tuesday, I went to my family practitioner. My family history is this: In 2004, an ultrasound for a reason I can't even recall, revealed a mass on my thyroid. Biopsy determined it was a hurthle cell neoplasm. Because those can turn quickly from nothing to bad and because it is impossible to tell if they are cancerous without removing the entire tumor, my entire thyroid was removed. It did turn out to be benign, but I was told it was still the right decision because of the reasons I listed above. I am 48 years old. I was overweight for several years, usually around 180 pounds, but reached 207 at Christmas of 2015. I decided once and for all to get back to my healthy weight of 135, so through eating right and walking, I have lost 51 pounds thus far and weigh now 156. In 1968, when I was born, my father, then 48 years old, was diagnosed with esphogael adenocarcinoma. He had smoked cigars, not regularly, but he did smoke them. He died in 1969 just weeks before his 50th birthday. My nephew had lymphoma in a mass behind his knee at the age of 9. He survived and is now 46 years old. I am the youngest of six children, none of whom have had cancer. I have never been a smoker but I do admit to smoking a cigarette once in a blue moon if I have an alcoholic beverage (I have maybe one to two drinks a year and don't always smoke when I do). In my lifetime, probably two-three packs of cigarettes ever. My family practitioner said it felt as though the mass was in my submandibular gland. I have not had any dental issues either, no teeth pain, neck pain, etc. He said after feeling my neck that he believes the mass is 8-10 ml. and recommended I return in 4 weeks, August 16th, where he will feel my neck again to see if he thinks it is growing or shrinking. Since it has been now three plus weeks since I found the mass and now I need to wait another three plus weeks, I am anxious. I wouldn't be, except my father died at such a young age from esophogael cancer, being diagnosed at the age I am now, and I did have a hurthle cell mass on my thyroid once before. Oh, also, just yesterday, I have now started with mild drainage down my throat and of course I'm hoping maybe the lymph node is swollen simply because I'm now getting sick, but realistically I know that it wouldn't swell three plus weeks before I have symptoms of being sick. What are your thoughts and recommendations?
Brief Answer:
?Firm Lymphnode with Sick feeling lately / Under Evaluation
Detailed Answer:
Brief Ans-?Firm Lymphnode with Sick feeling lately / Under Evaluation
Hi Dear !! Thanks for your query to HCM .
Read and reviewed your query and health concerns.
My opinion-
In the given situation, You seem to have suffered from sub-clinical hidden/undetected infection in throat/ or mouth,which is corroborated by your feeling of sickness with mild drainage in throat,lately.
But in view of your past history of Hurthle cell ?adenoma- a benign tumor of thyroid and your familial history of multiple cancers, I would suggest to re-confirm by needful investigations for following differential diagnosis-
-It could be just from subclinical Siladenitis- as opined from family doctor,
-or it could be from maxillary sinus infections - as you have history of throat drainage with sick feeling lately,
-Or it could be Thyroid malignancy with regional submandibular spread, which needs to be ruled after Histopathological report of its biopsy.
History Hurthle cell adenoma- raises this possibility, but when one considers that total thyroidectomy has done, at your younger age, to avoid possibility of thyroid cancers development in advanced age of sixties. Here your 48 yrs age also negates such a possibility.
And for this I would suggest a work up from ENT Surgeon and Dental Surgeon and General Surgeon team. Till their detailed investigation don't at all Worry about it being from cancer, due to merits discussed here in above.
But dear to give more possibilities of such a painless firm, sub-mandibular node, I would expect more details of past and present illnesses of throat and sinuses if any.Also update if you have any gastric trouble/indigestion in past or currently.
Also update if your have excess salivation/or pain in submandibular gland, eating citrus fruits
Please update More details on your health issues as told above and what you want exactly from this interaction.
After getting more details,I would give further suggestions on medicines to correct health issues.
If need be, update any health issue 24 x 7 by a direct question to ME, at following HCM link-http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=70229
Dear, if satisfied,Don't forget to close this query with YOUR pleasing feedback comments to rate this reply and service, to boost the morale of incoming Emergency patients like YOU, at HCM services.
If you want to update more details and ask more update queries ,
You are most Welcome herewith !!
Good Day!!
Wishing Good Healthy Life in time to come!!
Dr.Savaskar M.N. XXXXXXX Surgical Specialist
M.S.Genl-CVTSd
?Firm Lymphnode with Sick feeling lately / Under Evaluation
Detailed Answer:
Brief Ans-?Firm Lymphnode with Sick feeling lately / Under Evaluation
Hi Dear !! Thanks for your query to HCM .
Read and reviewed your query and health concerns.
My opinion-
In the given situation, You seem to have suffered from sub-clinical hidden/undetected infection in throat/ or mouth,which is corroborated by your feeling of sickness with mild drainage in throat,lately.
But in view of your past history of Hurthle cell ?adenoma- a benign tumor of thyroid and your familial history of multiple cancers, I would suggest to re-confirm by needful investigations for following differential diagnosis-
-It could be just from subclinical Siladenitis- as opined from family doctor,
-or it could be from maxillary sinus infections - as you have history of throat drainage with sick feeling lately,
-Or it could be Thyroid malignancy with regional submandibular spread, which needs to be ruled after Histopathological report of its biopsy.
History Hurthle cell adenoma- raises this possibility, but when one considers that total thyroidectomy has done, at your younger age, to avoid possibility of thyroid cancers development in advanced age of sixties. Here your 48 yrs age also negates such a possibility.
And for this I would suggest a work up from ENT Surgeon and Dental Surgeon and General Surgeon team. Till their detailed investigation don't at all Worry about it being from cancer, due to merits discussed here in above.
But dear to give more possibilities of such a painless firm, sub-mandibular node, I would expect more details of past and present illnesses of throat and sinuses if any.Also update if you have any gastric trouble/indigestion in past or currently.
Also update if your have excess salivation/or pain in submandibular gland, eating citrus fruits
Please update More details on your health issues as told above and what you want exactly from this interaction.
After getting more details,I would give further suggestions on medicines to correct health issues.
If need be, update any health issue 24 x 7 by a direct question to ME, at following HCM link-http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=70229
Dear, if satisfied,Don't forget to close this query with YOUR pleasing feedback comments to rate this reply and service, to boost the morale of incoming Emergency patients like YOU, at HCM services.
If you want to update more details and ask more update queries ,
You are most Welcome herewith !!
Good Day!!
Wishing Good Healthy Life in time to come!!
Dr.Savaskar M.N. XXXXXXX Surgical Specialist
M.S.Genl-CVTSd
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Thank you so much for responding. Here is additional information based on your comments. 1) I actually haven't been sick at all - in at least 6 months. Did not present with any drainage until last night, but I found the mass in my neck about three plus weeks ago. Since I didn't begin with any sickness until last night, I figured the two probably could not be connected. So could I have been having sinus issues for over three weeks with no symptoms other than mass until last night? 2) In 2012 I had complete successful sinus surgery as all sinus areas were completely occluded. I've had no sinus issues since that time, but I guess maybe sinuses could be acting up again although I've had no symptoms that I've been aware of. 3) I will follow up with ENT about the thyroid malignancy with possible submandibular spread even though thankfully you say that is remote based on my age and complete thyroidectomy 12 years ago. 4) I will follow your advice for work up from ENT, Dentist and General Surgeon so thank you. 5) You requested additional sinus and gastrointestinal issues. As I mentioned above, full successful sinus surgery in 2012 and no issues since then. Recent visit to dentist for routine cleaning and no issues there. GI issues - yes. When I lowered my caloric intake in an effort to lose weight, my bowel movements went to only twice a month, with no hard to pass stools, however, stools are slower and more difficult to pass possibly due to insufficient fiber. This resulted in a thrombosed external hemorrhoid. GI doctor added benefiber and Metamucil to my diet to help move things along. Thrombosed external hemorrhoid then healed on its own. Bowel movements still have not increased in frequency and are still slower to move. I have had occasional bouts of indigestion as well, which is unusual for me. It just seems things are moving more slowly through my GI tract although I used to eat three very heavy fatty meals and now I eat three very nutritious lower calorie meals and a few snacks daily. I also am not one to drink enough water, so keeping fully hydrated is sometimes an issue for me, but I am working on it. I have not noticed any pain eating, and haven't eaten citrus fruits in the past few weeks, so I don't know if those would cause any pain or discomfort. I do not have any pain in neck and although I have mild drainage as of last night down the back of my throat I do not have a sore throat and overall do not feel sick. 6) Also, I've now been feeling all over my face and neck, comparing left side to right side, trying to see if anything feels different from one side to the other. I do actually feel something hard, painless and immobile around my parotid as well, also on the left, that I do not feel on my right side. Never noticed it before so I have no idea how long it has been there. Thank you again for everything. I look forward to hearing from you again.
Brief Answer:
Hard nodule under left jaw / Under Evaluation
Detailed Answer:
Brief Ans-Hard nodule under left jaw / Under Evaluation
Hi Dear !! Thanks for your query to HCM .
Read and reviewed your query and health concerns.
Dear,While reviewing the updated data in all the details, I could guess the amount of anxiety and stress you are in. To resolve this,please go through My expert efforts as follows-
-My Comments after review of update details-
Dear,After review of the detailed marathon submissions,all my doubts have come true partly as off now,regarding sinus and Gi issues causing throat drain lately with sick feel.
To add to last story,your updated query facts indicate-you have sick feeling all on face and neck with firm left parotid.Besides this,presence of chronic malnutrition from commendable diet for weight reduction, with low appetite for water intake.
-My opinion-
In the given situation, You seem to be suffering from Chronic Sclerosing Sileadentis-CSS-(Submandibular/ and Parotid),with seek feeling spread over left side of face and neck.
Dear,In the given scenario and facts submitted,the cause of this firm left submandibular nodule-now seems to be narrowing down to Submandibular gland and parotid gland,as you confirmed painless firmness of left parotid in this 1st update .
-Differrential diagnosis-possibilities after 1st Update
Depending on My past experience and expertise thereafter,Cause of firm submandibular nodule with firm parotid with presence of drain down the throat with sickness feel in left face now narrows down to following possibilities-
-It could be-CSS(Chronic Sclerosing Sileadenitis) from autoimmune disease,
-or could be a Kuttner tumour (KT)with -sclerosing parotitis,
-or from Sjogren's Syndrome,
or it could be- indication of lymphoma,
-Possibilities of thyroid hurthle cell Carcinoma with distant submandibular node also needs to be kept in mind.
Dear other unmentioned causes need to be ruled out,which would be done by team of ENT/General and Onco- Surgeon.
What is the way out to confirm these causes?
I would need more details on few important lead questions,before giving My suggestions and solutions to it,so as to resolve your highly complex with challenging and intriguing health issues,causing worries to you lately.
-More Info please as follows-
Do You have dryness of mouth/eyes?if yes,since when?
How frequent and in what quantity in a day, you take fluids(water/juices/tea,coffee)?
Are you fond of tea ? how many cups a day?
Are you a known high bp / and or diabetic ?Since how long?List medicines in details?if any?
Please update picture of the nodule under left jaw,with side and front view,which would help me a lot.
Action plan-
This would need above info with details,upon which I would plan further suggestions with My expertise and 37 yrs of practicing experience
Please update More details on any other health issues as told above and what you want exactly from this interaction.
If need be, update any health issue 24 x 7 by a direct question to ME, at following HCM link-http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=70229
Dear, if satisfied,Don't forget to close this query with YOUR pleasing feedback comments to rate this reply and service, to boost the morale of incoming Emergency patients like YOU, at HCM services.
If you want to update more details and ask more update queries , You are most Welcome herewith !!
Good Day!! Wishing Good Healthy Life in time to come!!
Dr.Savaskar M.N. XXXXXXX Surgical Specialist
M.S.Genl-CVTS
Hard nodule under left jaw / Under Evaluation
Detailed Answer:
Brief Ans-Hard nodule under left jaw / Under Evaluation
Hi Dear !! Thanks for your query to HCM .
Read and reviewed your query and health concerns.
Dear,While reviewing the updated data in all the details, I could guess the amount of anxiety and stress you are in. To resolve this,please go through My expert efforts as follows-
-My Comments after review of update details-
Dear,After review of the detailed marathon submissions,all my doubts have come true partly as off now,regarding sinus and Gi issues causing throat drain lately with sick feel.
To add to last story,your updated query facts indicate-you have sick feeling all on face and neck with firm left parotid.Besides this,presence of chronic malnutrition from commendable diet for weight reduction, with low appetite for water intake.
-My opinion-
In the given situation, You seem to be suffering from Chronic Sclerosing Sileadentis-CSS-(Submandibular/ and Parotid),with seek feeling spread over left side of face and neck.
Dear,In the given scenario and facts submitted,the cause of this firm left submandibular nodule-now seems to be narrowing down to Submandibular gland and parotid gland,as you confirmed painless firmness of left parotid in this 1st update .
-Differrential diagnosis-possibilities after 1st Update
Depending on My past experience and expertise thereafter,Cause of firm submandibular nodule with firm parotid with presence of drain down the throat with sickness feel in left face now narrows down to following possibilities-
-It could be-CSS(Chronic Sclerosing Sileadenitis) from autoimmune disease,
-or could be a Kuttner tumour (KT)with -sclerosing parotitis,
-or from Sjogren's Syndrome,
or it could be- indication of lymphoma,
-Possibilities of thyroid hurthle cell Carcinoma with distant submandibular node also needs to be kept in mind.
Dear other unmentioned causes need to be ruled out,which would be done by team of ENT/General and Onco- Surgeon.
What is the way out to confirm these causes?
I would need more details on few important lead questions,before giving My suggestions and solutions to it,so as to resolve your highly complex with challenging and intriguing health issues,causing worries to you lately.
-More Info please as follows-
Do You have dryness of mouth/eyes?if yes,since when?
How frequent and in what quantity in a day, you take fluids(water/juices/tea,coffee)?
Are you fond of tea ? how many cups a day?
Are you a known high bp / and or diabetic ?Since how long?List medicines in details?if any?
Please update picture of the nodule under left jaw,with side and front view,which would help me a lot.
Action plan-
This would need above info with details,upon which I would plan further suggestions with My expertise and 37 yrs of practicing experience
Please update More details on any other health issues as told above and what you want exactly from this interaction.
If need be, update any health issue 24 x 7 by a direct question to ME, at following HCM link-http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=70229
Dear, if satisfied,Don't forget to close this query with YOUR pleasing feedback comments to rate this reply and service, to boost the morale of incoming Emergency patients like YOU, at HCM services.
If you want to update more details and ask more update queries , You are most Welcome herewith !!
Good Day!! Wishing Good Healthy Life in time to come!!
Dr.Savaskar M.N. XXXXXXX Surgical Specialist
M.S.Genl-CVTS
Above answer was peer-reviewed by :
Dr. Sonia Raina
Thank you so much. OK, the nodule is deep... no visible. Dry eyes off and on for quite a few months. I don't drink tea often but if I do, unsweet iced tea with low calorie sweetener. I don't drink water as often as I should - maybe one to two glasses/bottles a day so maybe 16-32 ounces at most and an occasional diet coke or an occasional decaf coffee but neither of those are daily. I always have low blood pressure - typically 100/60 and I have a low resting heart rate around 50 bpm. I am not diabetic. I am second guessing the parotid mass... it feels somewhat similar to the other side of my face, just slightly larger. But of course the family practitioner confirmed the 8-10ml mass on my neck which is definitely firm, painless and does not move. Thank you again for everything!! :)
Brief Answer:
Hard nodule under left jaw / Under Evaluation
Detailed Answer:
Brief Ans-Hard nodule under left jaw / Under Evaluation
Mostly from Sileadenitis of left submandibular Salivary gland.
Treatment would depend only after histo-path after FNAC or Biopsy.
Hi Dear !! Thanks for your 2nd updated query to HCM .
Read and reviewed your query and health concerns.
It seems you are satisfied with the interactions in last 2 replies.
Comments-
Dear,While reviewing the updated data of 2nd updates in all the details,your very low intake is mostly adding to your dry eyes.
Possibilities about firm nodule of 8-10 ml size under left jaw, are convincingly explained to you in last reply.
Primary Impression-
Mostly from Sileadenitis of left submandibular Salivary gland.
Treatment would depend only after histo-path after FNAC or Biopsy.
Do's Suggested-
Don't worry about odd possibilities,which are of academic interest.
This needs to be confirmed with Surgical Specialist, who would get FNAC / or Excisional Biopsy of the nodule and would confirm the exact nature of this painless node.
Also CT/MRI study would be needed to resolve Mystery of? firm larger parotid on left side.
Add another 600 ml to your fluid intake in form of juices / water etc.
Avoid coke to help you hydrate more.
In view of non-diabetic and non-hypertensive, no issues with it.
Plan of treatment-
Check with Family doctor for any rise in size of left hard nodule.
Get Consults and Second opinion from Surgeon.
Get CT neck/ parotids,to assess its structure.
Discuss with attending doctors on the possibilities they suggest.
Rule out discussed possibilities only if need be.
Contact again with special query, if need be,on the link at HCM given below.
Alerts-
After meeting with family doctor, get investigations done,after Second opinion from Surgical Specialist, who would be right person to take it further on treatment plans.
Please update More details on any other health issues as told above and what you want exactly from this interaction.
If need be, update any health issue 24 x 7 by a direct question to ME, at following HCM link-http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=70229
Dear, do close this query with YOUR pleasing feedback/ excellent comments to rate this reply and service, to boost the morale of incoming needy Emergency patients like YOU, at HCM services.
If you want to update more details and ask more update queries , You are most Welcome herewith !!
Good Day!! Wishing Good Healthy Life in time to come!!
Dr.Savaskar M.N.
XXXXXXX Surgical Specialist
M.S.Genl-CVTS
Hard nodule under left jaw / Under Evaluation
Detailed Answer:
Brief Ans-Hard nodule under left jaw / Under Evaluation
Mostly from Sileadenitis of left submandibular Salivary gland.
Treatment would depend only after histo-path after FNAC or Biopsy.
Hi Dear !! Thanks for your 2nd updated query to HCM .
Read and reviewed your query and health concerns.
It seems you are satisfied with the interactions in last 2 replies.
Comments-
Dear,While reviewing the updated data of 2nd updates in all the details,your very low intake is mostly adding to your dry eyes.
Possibilities about firm nodule of 8-10 ml size under left jaw, are convincingly explained to you in last reply.
Primary Impression-
Mostly from Sileadenitis of left submandibular Salivary gland.
Treatment would depend only after histo-path after FNAC or Biopsy.
Do's Suggested-
Don't worry about odd possibilities,which are of academic interest.
This needs to be confirmed with Surgical Specialist, who would get FNAC / or Excisional Biopsy of the nodule and would confirm the exact nature of this painless node.
Also CT/MRI study would be needed to resolve Mystery of? firm larger parotid on left side.
Add another 600 ml to your fluid intake in form of juices / water etc.
Avoid coke to help you hydrate more.
In view of non-diabetic and non-hypertensive, no issues with it.
Plan of treatment-
Check with Family doctor for any rise in size of left hard nodule.
Get Consults and Second opinion from Surgeon.
Get CT neck/ parotids,to assess its structure.
Discuss with attending doctors on the possibilities they suggest.
Rule out discussed possibilities only if need be.
Contact again with special query, if need be,on the link at HCM given below.
Alerts-
After meeting with family doctor, get investigations done,after Second opinion from Surgical Specialist, who would be right person to take it further on treatment plans.
Please update More details on any other health issues as told above and what you want exactly from this interaction.
If need be, update any health issue 24 x 7 by a direct question to ME, at following HCM link-http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=70229
Dear, do close this query with YOUR pleasing feedback/ excellent comments to rate this reply and service, to boost the morale of incoming needy Emergency patients like YOU, at HCM services.
If you want to update more details and ask more update queries , You are most Welcome herewith !!
Good Day!! Wishing Good Healthy Life in time to come!!
Dr.Savaskar M.N.
XXXXXXX Surgical Specialist
M.S.Genl-CVTS
Note: For further queries related to kidney problems Click here.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Answered by
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