Is there a risk of malignancy in the case of subcentimeter lymph nodes?

Hello,

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I have reviewed the attached clinical summary (attachments removed to protect the patient’s identity), which is very detailed and well-written, I must say. I have also reviewed the ultrasound (U/S) abdomen report.

Coming to your question: There are some enlarged lymph nodes, but even the largest one is less than 0.393 inches. These are known as subcentimeter lymph nodes. Considering your father's clinical history and multiple medical conditions, the likely possibility is reactive lymphadenopathy (enlargement of lymph nodes) or may be secondary to minor infections. The likelihood of malignancy is less considering the size of the lymph nodes, but older age is always a risk factor.

Suggestions: If he is clinically doing well, with no recent history of fever, altered bowel habits, or urinary complaints, one can repeat the ultrasound after six to eight weeks to compare the size of these nodes.

Please let me know if you want some help.

Thank you.

Hello,

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You are right regarding contrast-induced nephropathy in elderly patients with relatively compromised renal functions. There is always a risk versus benefits consideration when ordering investigations in elderly patients. If you opt for a CT (computed tomography) scan, you may obtain better answers, but there is a risk of contrast-induced nephropathy. On the other hand, if you choose to wait and watch, there is a risk of delaying diagnosis. As I explained earlier, lymph nodes less than 10 mm are usually not associated with malignancy, but age is a risk factor, which I agree with.

I suggest discussing the risks versus benefits with your nephrologist. There are certain ways to protect kidneys before contrast, such as proper hydration and sometimes N-acetylcysteine if needed. Unfortunately, no one can determine the best step, as both options have risks and benefits. It is not always about the symptoms in elderly patients; one cannot assume that if they are clinically well, everything internally is also well.

Thank you.

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A repeat ultrasound will help to compare sizes. If the size remains static or reduces, one can continue observation via ultrasound at least two times. If the size increases, the patient will need a CT scan for further evaluation. A CT scan with contrast is the best recommended second imaging after ultrasound because it is not only about the size of lymph nodes. A CT scan provides additional information regarding surrounding structures and helps to identify the primary source, God forbid, in the case of malignancy.

A PET scan focuses only on metabolically active areas in the body. It cannot differentiate 100 percent between infection focus and malignancy because both can be metabolically active. PET scans are usually used in cases where there is a known malignancy to determine whether it is localized to one point, spread to multiple points, or present in different parts of the body.

Kind regards.

Hello,

Welcome back to icliniq.com.

Yes, a good-quality CT scan with contrast can show large masses or lesions within the lumen. However, small lesions may be missed, and for them a colonoscopy will be recommended. No, electrolyte abnormalities are not known to cause gut malignancy in this scenario.

Kind regards.

Hello,

Welcome back to icliniq.com.

No, potassium is likely affected by diuretics, and bicarbonate increases due to steroid therapy because it causes metabolic alkalosis. I do not think it is gut-related. Yes, a repeat ultrasound can be considered after three to four weeks to compare sizes, especially if there is a higher risk of renal damage from a CT scan.

I hope your queries are resolved, and any further queries are welcome.

Thank you.