Enlarged Lymph Nodes: When to Seek Further Evaluation

Q: Enlarged Lymph Nodes: When to Seek Further Evaluation

Hello： Please visit an otolaryngologist to perform a neck lymph node biopsy (preferably with the same physician who performed the initial biopsy). <br>If possible, avoid needle aspiration and opt for an excisional biopsy of the entire lymph node, as it has greater diagnostic valu

Lymphadenopathy

Hello, I experienced a high fever in mid-April that lasted for three days, with the highest temperature reaching over 39 degrees Celsius.
After that, I noticed swelling in the lymph nodes on the right side of my neck.
When I consulted a doctor at that time, they suggested it might just be a result of the fever and did not pay much attention to it.
However, by early June, a friend pointed out that I had developed multiple swollen lymph nodes that were visibly enlarged.
I then visited an otolaryngologist who discovered a tumor in my nasopharynx.
I underwent two nasopharyngeal biopsy procedures; the first one yielded no results, while the second indicated only lymphoid hyperplasia.

Recently, I have been experiencing low-grade fevers for the past three to four days (around 37.3-37.8 degrees Celsius, with occasional spikes above 38 degrees).
Additionally, I have been experiencing night sweats and a sensation of heat in my body over the past couple of months, and the lymph nodes in my neck have not decreased in size.
I would like to ask the doctor if the tumor in my nasopharynx is not problematic, is there a possibility that I may need to undergo a biopsy of the cervical lymph nodes? I am concerned because my grandfather also had lymphoma.
Thank you.

L, 20~29 year old female. Ask Date: 2022/07/30

Dr. Chen Yunfang reply Oncology

Hello: Please visit an otolaryngologist to perform a neck lymph node biopsy (preferably with the same physician who performed the initial biopsy).
If possible, avoid needle aspiration and opt for an excisional biopsy of the entire lymph node, as it has greater diagnostic value.
Sometimes, insufficient sample size may lead to inconclusive results.
Thank you.

Reply Date: 2022/07/30

More Info

Enlarged lymph nodes can be a source of concern, especially when accompanied by systemic symptoms such as fever, night sweats, and persistent enlargement. In your case, the history of fever followed by the discovery of enlarged lymph nodes in the neck, along with the recent low-grade fevers and night sweats, warrants careful evaluation.

Lymph nodes can become enlarged due to a variety of reasons, including infections, inflammatory conditions, and malignancies. In your situation, the initial assessment by an ENT specialist indicated the presence of a nasopharyngeal tumor, which could potentially be related to the lymphadenopathy. The fact that the first biopsy did not yield any results while the second indicated reactive hyperplasia suggests that the lymph nodes are responding to some form of stimulus, which could be infectious or inflammatory in nature.

Given your symptoms, particularly the persistent fever and night sweats, it is essential to consider further evaluation. While reactive hyperplasia often indicates a benign process, the ongoing symptoms and family history of lymphoma raise valid concerns. Here are some steps you might consider:
1. Follow-Up with Your ENT Specialist: Since the ENT specialist has already evaluated your nasopharynx, it would be prudent to return for a follow-up. Discuss your ongoing symptoms and express your concerns regarding the lymph nodes and family history of lymphoma. They may recommend further imaging studies, such as a CT scan of the neck, to assess the lymph nodes' characteristics and any changes over time.

2. Consider a Fine Needle Aspiration (FNA) or Biopsy: If the lymph nodes remain enlarged and symptomatic, your doctor may suggest a fine needle aspiration biopsy. This procedure can help determine the nature of the lymphadenopathy and rule out malignancy. Given your family history, this may provide peace of mind or guide further management.

3. Monitor Symptoms: Keep a close watch on your symptoms. If you experience any new symptoms, such as significant weight loss, increased fatigue, or changes in appetite, report these to your healthcare provider promptly.

4. Blood Tests: Your doctor may also recommend blood tests to check for signs of infection, inflammation, or hematological conditions. Tests such as a complete blood count (CBC), inflammatory markers (like ESR or CRP), and specific viral or bacterial tests may be useful.

5. Referral to Hematology/Oncology: If there is any suspicion of malignancy based on imaging or biopsy results, a referral to a hematologist or oncologist may be necessary for further evaluation and management.

In summary, while the presence of enlarged lymph nodes can often be benign, your symptoms and family history suggest that further evaluation is warranted. It is crucial to maintain open communication with your healthcare providers and advocate for the necessary tests to ensure a thorough assessment of your condition. Early detection and intervention can significantly impact outcomes, especially in cases where malignancy is a concern.

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