Enlarged Clavicular Lymph Nodes: Concerns and Insights

Q: Enlarged Clavicular Lymph Nodes: Concerns and Insights

Hello： 1. <br>The cytology report indicates that the specimen is insufficient for diagnostic purposes, which means this test is not useful. <br>2. <br>Lymph nodes smaller than 1 cm should be biopsied (I mean excisional biopsy, where the entire node is removed for pathological exa

Enlargement of the supraclavicular lymph nodes?

Hello, Doctor! My mother is 67 years old.
She previously lived in China for an extended period while taking care of children.
During that time, she received the Sinopharm vaccine on June 24 of last year.
At the end of August, she noticed swelling in the lymph nodes above her collarbone.
She visited the hospital on August 25, where an ultrasound showed multiple lymph nodes from the bilateral neck to the supraclavicular area, with clear borders and partial medullary disappearance.
The left side appeared full, while the right side had a larger supraclavicular node measuring 18x9 mm, and the left side had a larger neck node measuring 13x6 mm, with more abundant blood flow signals on the left side.
My mother returned to the hospital for a follow-up on September 25, and the ultrasound again showed multiple lymph nodes from the bilateral neck to the supraclavicular area, with clear borders and partial medullary disappearance.
The left side appeared full, while the right side had a larger supraclavicular node measuring 11x6 mm, and the left side had a larger neck node measuring 18x10 mm, with less blood flow signals on the left side.
Given the suspicion of enlargement in the left lymph nodes, my mother underwent a fine needle aspiration biopsy of the left neck nodule 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 re-examination or further testing if necessary.
Notably, during the two ultrasound examinations (from August 25 to September 25 of last year), my mother experienced a generalized urticaria episode, despite having no previous history of hives.
Visually, the lymph nodes have significantly reduced in size and are almost undetectable, but they can still be palpated.
My mother has heard that swelling of the left lymph nodes is closely associated with cancer, which has caused her significant anxiety, and I am also very concerned.
I would like to ask the doctor: 1) Is the presence of very few atypical epithelial cells in the cytology examination considered abnormal? 2) Although the lymph nodes appear to have shrunk to a point where they are difficult to detect visually, is it concerning that they have not completely resolved to the point of being undetectable by touch? Is it clinically possible for lymph nodes to appear to be shrinking while actually increasing in size? 3) My mother has recently lost about 1 kg (she originally weighed slightly over 60 kg) and has been less active than before.
Should this raise any concerns? My mother has a history of heart disease and poor sleep.
Based on the information provided, can we essentially rule out the possibility of cancer? Thank you!

Happy Pig, 30~39 year old female. Ask Date: 2022/06/10

Dr. Chen Yunfang reply Oncology

Hello: 1.
The cytology report indicates that the specimen is insufficient for diagnostic purposes, which means this test is not useful.
2.
Lymph nodes smaller than 1 cm should be biopsied (I mean excisional biopsy, where the entire node is removed for pathological examination, not fine needle aspiration, as that often yields insufficient specimen volume and is therefore unproductive).
3.
These descriptions lack specificity, and I cannot associate them with cancer.
Thank you for your response.

Reply Date: 2022/06/10

More Info

Dear Patient,
Thank you for sharing your mother's medical history and concerns regarding her enlarged clavicular lymph nodes. I understand that this situation can be quite distressing, especially with the association of lymphadenopathy and cancer. Let’s address your questions one by one, providing clarity and insights based on medical knowledge.

1. Presence of Atypical Epithelial Cells: The report indicating "extremely few atypical epithelial cells" is noteworthy. In cytology, atypical cells can sometimes be a cause for concern, but the context is crucial. The presence of atypical cells does not automatically indicate malignancy, especially when the report states that no malignancy was observed. It suggests that there may be some reactive changes occurring, possibly due to inflammation or infection. However, it is essential to follow up with your healthcare provider for further evaluation, as they may recommend additional tests or monitoring to ensure that these atypical cells do not signify an underlying issue.

2. Lymph Node Size and Monitoring: The fact that the lymph nodes have visibly decreased in size is a positive sign. However, it is not uncommon for lymph nodes to remain palpable even after they have reduced in size. The concern arises when lymph nodes continue to grow or do not respond to treatment. In clinical practice, it is indeed possible for lymph nodes to appear to shrink while still harboring underlying pathology. Regular follow-up with imaging studies, such as ultrasound or CT scans, is advisable to monitor any changes in size or characteristics of the lymph nodes. If the lymph nodes remain stable or continue to decrease, it may suggest a benign process.

3. Weight Loss and Activity Level: A weight loss of 1 kilogram over a period, especially if accompanied by decreased activity levels, can be concerning, particularly in the context of underlying health issues. While this amount of weight loss alone may not be alarming, it is essential to consider it in conjunction with other symptoms. Given your mother’s heart condition and sleep issues, it would be prudent to discuss these changes with her healthcare provider. They may want to evaluate her overall health, including her cardiac status, to rule out any potential complications or the need for intervention.

Regarding the possibility of cancer, while the presence of enlarged lymph nodes can be associated with malignancy, it is not definitive. The cytology results, along with the decrease in lymph node size and the absence of malignancy in the fine needle aspiration, suggest that cancer is less likely. However, it is essential to maintain vigilance and continue with follow-up appointments and any recommended imaging or laboratory tests.

In summary, while the findings you have shared do not strongly indicate cancer, it is crucial to remain proactive in monitoring your mother's health. Regular follow-ups with her healthcare provider, addressing any new symptoms, and maintaining open communication about her concerns will be vital in managing her health effectively. Encourage her to stay engaged with her healthcare team, as they can provide the most personalized and accurate guidance based on her evolving clinical picture.

Wishing you and your mother the best of health and peace of mind.

Sincerely,
Doctor Q&A Teams

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