Enlarged Left Supraclavicular Lymph Nodes: Concerns and Insights

Left supraclavicular lymph nodes

Hello, Doctor! My mother is 67 years old.
She lived in China for an extended period while caring for children and received the Sinopharm vaccine on June 24 of last year.
At the end of August, she discovered swollen lymph nodes above her clavicle during a self-examination and went to see a doctor on August 25.
An ultrasound showed multiple lymph nodes from the bilateral neck to the supraclavicular area, with clear borders and partial loss of the medullary pattern.
The left side appeared full, while the right side had a larger supraclavicular node measuring 18 x 9 mm, and the left side had a larger neck node measuring 13 x 6 mm, with more abundant blood flow signals on the left side.

On September 25, she returned for a follow-up ultrasound, which again showed multiple lymph nodes from the bilateral neck to the supraclavicular area, with clear borders and partial loss of the medullary pattern.
The right supraclavicular node measured 11 x 6 mm, and the left neck node measured 18 x 10 mm, with less blood flow signal on the left side.
Given the suspicion of enlargement of the left lymph node, she underwent a fine needle aspiration biopsy of the left neck node on September 28.
The report indicated the presence of lymphocytes, a small number of tissue cells, and very few atypical epithelial cells, with no malignant findings observed in the smear.
It suggested further examination if necessary.
It is worth mentioning that during the period between the two ultrasounds (from August 25 to September 25), my mother experienced a full-body rash, which was unusual for her as she had no prior history of rashes.
Therefore, I have been wondering if this could be related to the vaccine she received.
Visually, the lymph nodes have significantly reduced in size and are almost imperceptible, but they can still be palpated, and there are no signs of further enlargement.
My mother has heard that swollen lymph nodes on the left side are closely associated with cancer, which has caused her great anxiety, and I am also very concerned.
My mother’s main worries are: 1) Is the presence of very few atypical epithelial cells in the cytology report abnormal? 2) Although the lymph nodes have shrunk, is it a cause for concern that they have not completely resolved to the point of being undetectable? 3) My mother has lost about 1 kilogram in weight over the past week and has not been as active as before; should this raise any alarms?
Based on the information provided, can we essentially rule out the possibility of cancer? Thank you!

Happy Flying Pig, 60~69 year old female. Ask Date: 2022/05/12

Dr. Zheng Jueyi reply Otolaryngology

Hello, it is not possible to completely rule out malignancy.
It is recommended to continue regular follow-ups.
If the lymph nodes continue to enlarge or increase in number, further biopsy may need to be considered.
Wishing you safety and health.
Sincerely, Dr.
Cheng Jue-Yi, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2022/05/12

More Info

Understanding enlarged lymph nodes, particularly in the supraclavicular region, can be a source of significant concern for patients and their families. In your mother's case, the findings from her ultrasound and fine needle aspiration cytology (FNAC) provide important insights into her condition.

1. Presence of Atypical Cells: The report indicating "extremely few atypical epithelial cells" is noteworthy. Atypical cells can be a cause for concern, but their presence does not automatically indicate malignancy. In many cases, atypical cells can be reactive due to inflammation or infection rather than cancer. The fact that the cytology report did not show any malignant cells is reassuring. It suggests that while there may be some atypical changes, they are not definitive for cancer at this time.

2. Lymph Node Size and Changes: The reduction in the size of the lymph nodes is a positive sign. Lymph nodes can remain palpable for some time even after they have begun to resolve, especially if they were previously enlarged. The key factor is whether they continue to grow or change in character. Since you mentioned that there have been no further increases in size and that they have visibly shrunk, this is generally a good indicator. Continuous monitoring is advisable, but the absence of growth is encouraging.

3. Weight Loss and Activity Levels: A weight loss of 1 kilogram over a week, combined with decreased activity levels, can be concerning, especially in the context of a previously healthy individual. While this may not necessarily indicate a serious issue, it is essential to consider the overall clinical picture. If your mother is experiencing other symptoms such as fatigue, fever, night sweats, or persistent pain, these could warrant further investigation. It is advisable to discuss these changes with her healthcare provider, as they may recommend additional tests or follow-up appointments to ensure her health is monitored closely.

4. Cancer Concerns: Based on the information provided, it is reasonable to be cautiously optimistic. The absence of malignant cells in the FNAC, along with the reduction in lymph node size, suggests that the likelihood of cancer is low at this point. However, the presence of atypical cells and the recent weight loss should not be ignored. Regular follow-ups with her healthcare provider are essential to monitor her condition and to address any new symptoms that may arise.

5. Vaccination and Symptoms: Regarding your concerns about the potential link between the recent vaccination and the development of lymphadenopathy, it is known that vaccinations can sometimes cause reactive lymphadenopathy as the immune system responds to the vaccine. This is typically a benign process and resolves over time. However, if there are ongoing concerns about the vaccine's effects, it would be beneficial to discuss these with her healthcare provider.

In conclusion, while the findings from the FNAC and the ultrasound are reassuring, it is crucial to maintain open communication with her healthcare team. Regular monitoring and follow-up appointments will help ensure that any changes in her condition are addressed promptly. Encourage your mother to share her concerns with her doctor, especially regarding her weight loss and any other symptoms she may be experiencing. This proactive approach will help alleviate anxiety and ensure her health is managed effectively.

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