Lymph Node Issues: Key Questions and Insights - Oncology

Lymphatic issues

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Hello Doctor, I would like to inquire about lymphatic issues:
1.
Self-reported:
1.
On May 25, 2022, I discovered a movable, non-painful, neither soft nor hard mass on the right side of my neck.
2.
On May 25, 2022, I found a movable, non-painful, neither soft nor hard mass on the right side of my groin.
3.
On May 25, 2022, I noticed a movable, non-painful, neither soft nor hard mass on the left side of my groin, which I may have discovered earlier, specifically before going to bed when I felt it while playing.
4.
No masses were found under the armpit or behind the knee.
5.
No fever, itching, sweating, skin changes, or weight loss.
6.
Abdominal ultrasound on May 4, 2022: normal.
7.
On May 26, 2022, mild kidney stones, hydronephrosis, fecal impaction in the intestines, and urinary tract infection were noted.
8.
Gastroscopy on July 5, 2022: superficial gastritis, gastroesophageal reflux, no Helicobacter pylori.
9.
Colonoscopy on July 5, 2022: 0.3 cm colonic hyperplastic polyp removed.
Mixed hemorrhoids.
10.
Low-dose CT scan on July 5, 2022: normal.
11.
Intravenous pyelography on July 5, 2022: suspected right renal ptosis.
12.
Anoscopy on August 15, 2022: three internal hemorrhoids with congestion, blood after defecation.
13.
Complete blood count on August 17, 2022: only MPV was abnormal at 6.2 (normal range 7.5-11.4).
14.
On August 17, 2022: negative for Hepatitis B and C.
15.
LDH: 179 (normal range 98-192).
16.
As of today: bilateral tennis elbow and slight gum pain around the last upper molar with daily flossing.
17.
As of today: the three lymphatic sites feel neither enlarged nor reduced.
2.
Other physicians performed ultrasound, endoscopy, and aspiration:
1.
On May 25, ultrasound showed a low-density ovoid mass about 1.1 cm in size just above the fascial layer over the right side of the neck.
The left inguinal region showed a normal lymph node at 0.9 cm.
The right inguinal region showed a normal lymph node at 0.6 cm.
2.
Nasopharyngoscopy on August 15: normal.
3.
Ultrasound (neck) and aspiration (neck) on August 23: (1) one lymphadenopathy measuring 7.4mm x 4.1mm x 14.1mm with hilum (+) over right neck zone V.
(2) Specimen: lymph node, right neck level V, aspiration, 1 air-dried slide x Quick Giemsa Stain, 1 alcohol-fixed slide x Papanicolaou Stain.
Interpretation: Non-diagnostic.
Presence of PMNs and RBCs only.
No discernible lymphoid cells are noted.
Re-aspirate if clinically needed.
3.
Questions:
1.
Is the size of the lymph nodes observed in the ultrasound within the normal range? Can the measurements vary between different physicians?
2.
With an LDH of 179 (normal range 98-192), is this value considered elevated? It seems to be gradually increasing and may soon exceed the upper limit.
Could this slow progression lead to exceeding 192?
3.
Regarding the statement "No discernible lymphoid cells are noted," is it possible that the aspiration was performed at the wrong location? I believe that if the correct area was aspirated, lymphoid cells should be present.
What does this statement imply?
4.
The self-reported examinations are based on recollections of tests conducted during that period.
What other tests can I undergo, Doctor?
5.
If it were lymphoma, could there be a situation where the lymph nodes in the neck are malignant while those in the groin are benign? Or would they all have to be either malignant or benign?
6.
After the left groin lymph node was excised on August 23, I was prescribed antibiotics (report not yet available), but the other two nodes have not decreased in size.
Could frequent palpation prevent them from shrinking? I am concerned that these three sites have not diminished for a long time.
4.
Regarding follow-up with the same physician for ultrasound monitoring of the same area, they stated there was no change, but I can palpate a distinct movable mass, so I am seeking a second opinion.
Thank you, Doctor.

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Chris, 30~39 year old female. Ask Date: 2022/08/28