Lymph Node Hyperplasia and Subcutaneous Nodules in the Abdomen

Q: Lymph Node Hyperplasia and Subcutaneous Nodules in the Abdomen

Hello： Based on what you described, those small nodules can only be definitively diagnosed through a pathological biopsy; speculation is merely speculation! However, if it is indeed a malignant cancer, it would typically grow rapidly, making it unlikely to be observed for an exte

Lymphadenopathy and subcutaneous nodules in the abdomen?

Hello Doctor: About four months ago, I discovered a lymph node approximately 1.5 cm in size on the left side of my neck (at position 2A), and there is also a lymph node around 1 cm on the right side.
A fine needle aspiration performed at National Taiwan University Hospital indicated benign lymphoid hyperplasia.
However, since the discovery, these nodes have not decreased in size and feel somewhat firm.
Additionally, I have lymph nodes of about 1 cm on both sides of my jaw, which have also been firm and have not changed over the past 12 to 13 years.
I would like to ask if it is normal for benign lymphoid hyperplasia to persist without regression, especially in the case of the jaw lymph nodes that have remained unchanged for over a decade.
If the lymph nodes are congenitally enlarged, would the aspiration results still indicate lymphoid hyperplasia?
Another issue is that about four months ago, I started to notice swelling under the left rib cage, and subsequently, I felt some flat, firm nodules (approximately 0.5 cm) in that area.
Now, I can also feel somewhat oval or elongated nodules that are soft and firm in the subcutaneous tissue from the left rectus abdominis area down to the pubic region.
The skin over these nodules shows no changes, but when I pinch and knead the skin, I can feel a tightness and a foreign body sensation in those areas.
The nodules themselves are growing slowly and are not large.
I am wondering if this could be nodular fasciitis, or if there is a possibility of lipomas or fibromas? I consulted a surgeon at a small hospital, but he referred me to a plastic surgeon due to insufficient experience.
The plastic surgeon mentioned that he couldn't palpate them well and did not perform a biopsy.
However, I feel that the number of nodules is increasing, even though they are not growing significantly in size.
I hope you can provide some insights.
Thank you, and I wish you peace and joy.

Xiao A, 20~29 year old female. Ask Date: 2016/05/27

Dr. Chen Yunfang reply Oncology

Hello: Based on what you described, those small nodules can only be definitively diagnosed through a pathological biopsy; speculation is merely speculation! However, if it is indeed a malignant cancer, it would typically grow rapidly, making it unlikely to be observed for an extended period as you mentioned.
I would still recommend that you seek a major hospital for the biopsy, as it is crucial for accurate diagnosis.
Thank you for your understanding.

Reply Date: 2016/05/27

More Info

Understanding lymph node hyperplasia and subcutaneous nodules can be quite complex, especially when considering the nuances of benign versus malignant conditions. Based on your description, it appears that you have been dealing with lymph nodes that have been assessed as benign lymphoid hyperplasia, which is a non-cancerous enlargement of lymph nodes. This condition can occur for various reasons, including infections, inflammation, or immune responses.

Lymph Node Hyperplasia
Lymph nodes are small, bean-shaped structures that play a crucial role in the body's immune system. They can become enlarged due to various factors, including infections (like viral or bacterial infections), autoimmune diseases, or even as a reaction to certain medications. In your case, the fine needle aspiration (FNA) biopsy results indicating benign lymphoid hyperplasia suggest that the lymph nodes are responding to some form of stimulus, likely an ongoing immune response.

It is not uncommon for lymph nodes to remain enlarged for extended periods, even years, especially if they have been subjected to chronic stimulation. The hardness you describe may be due to fibrous tissue formation within the lymph nodes, which can occur as a part of the healing process or chronic inflammation. The fact that these nodes have not changed significantly over 12-13 years may indicate that they are stable and not indicative of malignancy, especially since they have been evaluated and deemed benign.

Subcutaneous Nodules
Regarding the subcutaneous nodules you have noticed in the abdominal area, there are several possibilities. The characteristics you describe—small, firm nodules that are soft to the touch and have been present for a while—could suggest a few different conditions:
1. Lipomas: These are benign tumors made of fatty tissue. They are usually soft, movable, and painless. They can vary in size and may grow slowly over time.

2. Fibromas: These are benign tumors made of fibrous or connective tissue. They can also be firm and may feel like a hard lump under the skin.

3. Nodular Fasciitis: This is a benign condition characterized by a rapidly growing mass of fibrous tissue. It is often mistaken for a malignant tumor but is non-cancerous.

4. Mucous Cysts or Ganglion Cysts: These can also present as nodules under the skin, particularly if they are located near joints or tendons.

5. Lymphadenopathy: Although your lymph nodes have been assessed as benign, it is still possible for lymph nodes to become reactive and form nodules in response to local inflammation or infection.

Recommendations
Given the complexity of your symptoms and the history of your lymph nodes, it is advisable to continue monitoring these nodules. If they change in size, shape, or consistency, or if you develop new symptoms (such as pain, fever, or unexplained weight loss), it would be prudent to seek further evaluation.

In terms of management, if the nodules are causing discomfort or concern, a consultation with a specialist, such as a surgeon or dermatologist, may be warranted. They can perform a physical examination and may recommend imaging studies or a biopsy if necessary to rule out any potential malignancy or to confirm the diagnosis.

In conclusion, while benign lymph node hyperplasia and subcutaneous nodules can be concerning, they are often manageable and do not necessarily indicate a serious underlying condition. Regular follow-ups with your healthcare provider are essential to ensure that any changes in your condition are promptly addressed.

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