Do painful and inflamed lymph nodes suggest lymphoma?

Hello doctor,

I had inflamed and painful lymph nodes for a few months. I checked with a doctor, who advised me to take a few tests. My blood test shows high interleukin receptor 2 levels. Fine needle aspiration cytology of the inflamed lymph nodes showed benign changes. I am worried that I have lymphoma.

Please help.

Hello doctor,

Thank you for the reply.

What could be the reason for my inflamed lymph nodes and the pain around the collarbone? Do you think the biopsy of one of the lymph nodes is enough?

Please give your suggestions.

Hello doctor,

Thanks for your reply.

Do I need to worry about my inflamed lymph nodes, which are painful at times? Why do you believe I have inflammation and not lymphoma or leukemia?

Please help me.

Hello doctor,

Thank you for your reply.

Is there a way to discover why the lymph nodes are reactive all over my body? I am worried because the doctor who did my CT scan, fine needle aspiration, and blood test told me before the biopsy that there is a possibility for malignant lymphoma. The radiologist spotted, on the right side of my neck, under my jaw, a bright white cloud in the middle of the lymph node. What could it be? Is there a reason for concern?

Please help.

Hi doctor,

Thank you for the reply,

How about in leukemia? Is any of the symptoms or results leading to this?

My main worry is that I have no fever, no tiredness, no night sweats, and no weight loss (apart from the weight loss I did for my wedding same time, my lymph nodes got inflamed, but it was intentional, not because I had sickness) and no loss of appetite. However, when you say one of the symptoms could be bone pain, it is exactly what I am kind of describing (the pain around the collarbone, the pain around my groin. Somehow, it could be lymph node pain, but it could also be bone pain). I do not have bone pain anywhere on my back or hands, just little dull pain around the groin and collarbone and sometimes the shoulders. Not every day, but it started. Again, considering the results, which were good, the IL2 was 917 (which the doctor was most worried about), and the lymph nodes under the armpits and on my neck and head are inflamed. I start to worry if I have bone pain too.

Would the fine needle aspiration show abnormal cells if I did have lymphoma or leukemia? And would my general blood work show high or very low red blood or white blood counts if I had one of these diseases? Would the CT scan have detected this?

As for the calcification, I do not know for sure, but I do not think I had it with the previous echography. Or at least it is not mentioned in the report. Could it be bad since the radiologist compared it to the left side, which did not have it?

And additionally, why the lymph nodes came for two months without any pain, and two months later, they started to hurt around the neck, under the armpit, and in the groin? What caused them to start being painful suddenly and only on and off?

Hi doctor,

Thank you for the reply,

To be honest, my pain is around the femur, not always dull, but I feel it sometimes around the left and right side, where the thigh starts, near the groin area, where the thigh moves the whole leg. Mainly on top (front side), not at the back. Also, around the collarbone and the shoulder, which I believe is what humorous is. No tibia pain. I am attaching an image, so you can see that blue is where I feel pain sometimes. For example, while I was writing you this message, it hurt me on the left thigh part. Yesterday was hurting me on the right and sometimes around the shoulder. Pain is very dull, not sharp, but it worries me as to why it hurts. As to the lymph nodes pain, under my armpits, they hurt, but I cannot touch them because they are not on the surface. Yesterday I was doing light exercise at the gym, and both underarms started to hurt.

From all I explained above and also seeing my results, you do not believe I have either lymphoma or leukemia? Could it be a different type of cancer?

I also forgot to ask, what would be my blood results (like the ones I sent) if I had leukemia? And which blood results would typically indicate it could be leukemia from the ones I did?

Hi doctor,

Thank you for the reply,

Basically from all the chats we did between us, you do not believe I have either lymphoma or leukemia, correct?

Hello doctor,

Thank you for the reply,

I received my results from the follow-up. From the echography around the neck, there was no change (neither getting bigger nor getting smaller). The blood test, however (IL2 receptor), which used to be 917, this time was 1150. It is increased, so this is why the doctor said I have to keep checking every one or two months. He said it increases with inflammation and lymphoma (he is an ears, nose, and throat doctor). However, everything else seems to be fine, at least what the doctor said. He proposed to do a biopsy with a bigger needle and check again if there was anything in the lymph nodes, but he said it was unnecessary and that we could do it later if the IL2 receptor kept rising. So we decided not to do another biopsy this time. I did mention my bones hurt, and I also asked him if we should do a test for the Ebstein-Barr virus and for mononucleosis. He agreed, and I did additional tests today, which I am attaching.

What do you think? Why do you think the IL2 is increasing?

Hi doctor,

Thank you for the reply,

I am sorry about the attachment, and I will send it again.

The EBV test will show whether I have had it in the past (not whether I have it now, since the doctor thought I have the symptoms and most likely I do not have it at the moment anymore). If I had it, what would this show me? That the EBV inflames the lymph nodes?

The doctor offered to do the thicker needle biopsy (not sure what it is called, but not the surgery), if it would make me relaxed, yet he believes we could wait until we check the Il2 one more time and see if it is growing again.

I know you believe I am fine; this is what the doctor today also said by the way he touches my lymph nodes, by the echography. He also said there are people with inflammation with this kind of result (if it were 3000 or 4000 would be suspicious, but I am not there yet), and he also said some people have high Il2 always. Is that true? What could be the reason for it growing if it is not lymphoma?

I just wanted to show you what he wanted to check, including the EBV. For the other tests, I told you verbally that lymph nodes in the neck had no change and IL2 1150. However, I do not know if the lymph nodes under the armpits are growing. Do you think the neck lymph nodes would also grow if they grow? I asked about a CT scan, but the doctor did not think it was necessary.

Hi doctor,

Thank you for the reply,

I will update you again when I get the EBV. However, I wonder if we did the right thing in testing if I have had it instead of if I have it right now.

The doctor suggested testing if I have had it (as in the past). Is it better to test whether I have it now? For the IL2, what is the highest it could raise with reactive nodes? With your experience, have you had patients with years with results like mine but not lymphoma?

And one last thing, what if I have lymphoma, but the virus affects a lymph node under my armpit or groin (for example)? Still, we keep doing biopsies from the neck lymph nodes, and they keep showing normal whereas in reality, the cancerous nodes are somewhere we do not do a biopsy. How we would find out a lymphoma if this happens?

Hi doctor,

Thank you for the reply,

Just one thing I believe you did not respond to:

If we only do the biopsy from neck lymph nodes and they all keep coming normal, but let us say the cancerous lymph node is the one in the groin or under the armpit, then how will we find out if it is lymphoma? I should do a biopsy not only on the neck. Currently, the doctor suggests only for the neck. Would this be sufficient, or anyway with lymphoma, most lymph nodes affected therefore safe to say if neck lymph nodes are negative for cancer, it also means the groin and armpit ones are negative.

Hi doctor,

Thank you for the reply,

I will send the EBV result when I get it.

Despite everything, do you still believe this is not a lymphoma?

Hello doctor,

I received the results from the 3 hospitals I go to (the neurosurgeon, friend of my family who tested for RF and today he tested also for Sjorgen syndrome, but the result will be ready next week), the ENT doctor in the university clinic, where they were worrying I might have lymphoma (they tested for EBV antibodies) and the Hashimoto hospital I go to (since my TSH results were quite low and the doctor adjusted the doze of Levothyroxine I take). Please, have a look and let me know what you think about the results. It seems we still do not know the reason for the inflammation and the lymph nodes. It is neither EBV, nor Rheumatism. The neurosurgeon said he believes the muscle and joint aches, could be from the Levothyroxine, since I have been taking higher doze according to what he thinks (I take usually 100 mcg but today the endocrinologist reduced it to 75 mcg). I also worry, why my liver function is so high. In November it was not. I wonder if this is also the side effect of the high doze levothyroxine. In any case I would like to hear your opinion about my situation, the suspicion of lymphoma, etc?

Thank you.

Hello doctor,

Could the EBV infection in the past mean that it happened when I was a child and might not be related to the reactive or non-malignant lymph nodes? I am still wondering what it could be and why my muscles or joints hurt, especially around the groin. If it is not RF or EBV, then what could it be? I keep worrying it might be lymphoma. What do you think? Kindly suggest.

Hello doctor,

When I was around 10 years old, I had enlarged and painful lymph nodes under my armpits that lasted a while. My dad brought me to a doctor who said it would pass by, and the doctor had such reactive lymph nodes. At some point, they went down, but I do not remember well after how long. 24 years later, I had them again also around the neck, and the IL-2 level was 1150 pg/ml. I wonder whether I had EBV around childhood. Because of my reactive lymph nodes when I was a kid, my doctor believes that I am a person who easily develops reactive nodes. And on echo graphs, they do not grow so far (at least these on the neck, which says it is good). The joint pain, he believes, is from the Levothyroxine doze, which was too high for my Hashimoto, and he believes this causes the aches and probably the lymph node inflammation as well. My TSH was below the normal range. Do you believe this could be the cause? Apart from this, I do not have any other symptoms. I was taking Chinese traditional medicine, and today the doctor told me that could be the reason for the high liver results, so we stopped the Chinese medicine for a while. I generally feel well, with no fever and no sweat at night, just the pain in the joints and the lymph nodes. And the IL-2, which is 1150 pg/ml. Do you continue to believe this is not lymphoma? Would I have had different symptoms within four months if it was a lymphoma?

Hello doctor,

I really hope so, doctor! I am super worried, to be honest, as currently, all autoimmune tests come out negative, and I am waiting for the Sjorgen syndrome test. But I do not have dry eyes or mouth, so I doubt it is that. I think I may have Hepatitis, but I also do not have the usual symptoms like tiredness or anorexia. Perhaps I should test just in case. I will check the echo, IL-2 receptor, and core biopsy again, depending on the result in the middle or end of this month. I wonder if you think I should do CT or PET scans again, and if yes, which? Is it possible that I have a low-grade Non-Hodgkin lymphoma developing very slowly? If you think not, may I ask you why? Perhaps low-grade lymphoma has other symptoms as well? Kindly suggest.

Hello doctor,

I am ruling out one by one the autoimmune diseases, as they are not all covered by national insurance when done in one go. Therefore, the doctor is doing each one by one, starting with the RF (which was negative), then the Syorgen syndrome, and I believe next might be RNP and RNA, even though I do not understand well what this is. I wonder if I should also test for hepatitis and lupus, just in case. If there are any other tests I should do under the ENA, please let me know. My microsome test (I guess related to the RF) was 800 mg/kg, with a normal range of less than 100 mg/kg. The doctor said his wife has rheumatoid arthritis, and she's usually 100,000 mg/kg. Do you know what could cause my microsome test to be 800 mg/kg and not below 100 mg/kg?

I will go to the university hospital and will ask if they can check beta-2 microglobulin. What would be considered a significantly raised result with beta-2? As to my biopsy on the lymph node, which was negative, that was a fine needle aspiration, not a core biopsy. We talked about this previously, but do you think the fine needle is quite accurate and could be trusted? I spoke to a second-opinion doctor, who asked how did the ENT decide to take fine needle aspiration exactly from that specific lymph node? It seems to him pretty random, as the ENT was wondering whether to take from the lymph node under the jaw, from either the left or right side. He then took from the left side. The second opinion doctor said, usually a sample would be taken from the most suspicious node according to an echo or CT scan (which I did, but I suppose there were no suspicious ones, just enlarged ones. Therefore, the doctor decided to take it from the biggest one). What is your opinion about this, doctor?

And last, since the beginning, I have had three lymph nodes on the back of my head. They appeared first, and a week later, when I got sick, the lymph nodes on my neck appeared too. Therefore I got scared. The ENT says they can not do a biopsy from the head lymph nodes as I have hair there. Also, the CT scan was done from my jaw below, meaning they never checked the lymph nodes on the head. Is there anything I could request for the lymph nodes on the head? They are around 1 cm, according to the doctor, and I can feel they have not changed in size. The doctor says they are movable, but I do not feel them moving much as they are around the bones on my head, and I guess they are difficult to move.

The ENT seems to be able to only check the lymph nodes or biopsy on the neck. He can not do the core biopsy in the groin lymph nodes or under the armpit. What type of doctors could do a core biopsy around these two areas? Thank you for answering all my questions. I really appreciate it.

Hello doctor,

The hospital here cannot refer me to hematologists unless I have lymphoma. Therefore I go to the ENT doctor in the university hospital, and a neurosurgeon doctor who is a friend of my family, who acts as a general practitioner and tests me for all autoimmune diseases since the ENT does not check me for this. But follows up on the neck lymph nodes and checks blood work for whatever I ask him. The EB virus was my request; for example, the ENT did not mention it. So, therefore, you are the only hematologist with more lymphoma experience, and your advice is very appreciated.

Quick questions:

1. Where did you see that I have checked for ANA? Is microsome test for lupus?

2. What does the microsome test show? What is it related to? I thought it was related to the RF, but since the RF was negative, the microsome test does not matter. I am totally confused. What is the microsome test supposed to show me being elevated to 800 mg/kg instead of 100 mg/kg? What autoimmune disease does the microsome test predict?

3. What does it mean if 'there is no contraindication of biopsy from the head'?

4. How is it possible that I might have hepatitis as an autoimmune disease? I am not a drinker or a drug user, so how could this happen? Is it also not possible to have it since I do not have anorexia, yellow color on the eyes, or fatigue? I feel totally fine and energetic.

5. Yesterday, you mentioned 'childhood EBV igG could not last that long.' Does this mean that my EB virus antigen result 10.4+ would be much lower if I had it in childhood, while 10.4+ indicates that it seems to be a sooner infection? Therefore, we could suspect EB is the reason.

6. If the answer to point 5 is yes, the results show it probably was a recent infection, then why did the lymph nodes not subside, and did the IL-2 increase slowly? Also, the nodes went from painless to painful, too painful only in the groin.

Thank you again. Looking forward to your reply.

Hello doctor,

The blood test was slightly better, the liver was getting into the normal range. The echography showed no change in the size of the cervical lymph nodes on the left neck and on the right side, they were normal (not inflamed anymore). Somehow the CK was a bit high this time, we did not understand why. The doctor asked me if I have exercised the day before, but I had exercised 5 days before that. The doctor could not confirm what is the cause.

The doctor did again camera through the nose and the throat, and everything looked good. He touched again the nodes on the left side and felt they are smaller, which I also believe, but the echography report showed they are the same as before (13mm). The doctor suggested since we had some good news, to follow up again in 2 months, but I requested a core biopsy of the lymph node on the left side (the 13mm one), which does not grow and does not become smaller. The doctor did FNA and FNB. The result came out today. I am very confused about it and the doctor is also not sure how to interpret it, saying they can not confirm whether I have slow-growing lymphoma or reactive lymph nodes (inflammation). He even called the laboratory to ask for more information, it seems it is not possible for the laboratory to distinguish between reactive or low-grade B-cell lymphoma. Both FNA and FNB say difficult to distinguish malignancy, as clear malignant findings can not be confirmed, but low-grade lymphoma can not be ruled out). The FNB report includes more information, which I am incapable of understanding without a medical degree and there is a diagnosis of atypical lymphoid cell infiltration below in the notes: The disintegration makes it difficult to distinguish between reactive lymphoid follicular hyperplasia and low-grade B-cell lymphoma. The doctor believes we can wait and meet again in 2 months and follow up with echography and IL2 receptor again.

Please, advise as I am very worried. In the meantime, the TSH, which was too low in January, and my medicine was adjusted, is now in the normal range, therefore my muscle/bone pain also stopped. I wonder since adjusting the medicine, this is also perhaps influenced my better results with the lymph nodes, but we are not sure. The endocrinologist says they are not connected. I look forward to your reply, I will appreciate any information you can give me and your personal opinion.

Thank you.

Hello doctor,

Could you please explain me a bit more? I am quite worried because I do not understand in detail the report. Could you please explain to me why the biopsy favors lymphoproliferative disorder? What gives you this impression? Because my worry is that the results show atypical lymphoid cell infiltration which means they can not distinguish between low-grade B-cell lymphoma and reactive lymph nodes. Of course, what you tell me gives me hope but I read the results negatively somehow. Also, what would CD20 and Ki67 show? What do they mean?

Currently, the doctor and we decided to come back in two months and do an echo and IL2 receptor test again, and if the result is not better to do the excision biopsy as it will be surgery and it will leave a scar on my neck. Do you think it is fine to wait and do the usual follow-up and then if really necessary the excisional biopsy or do you think I should do the excisional biopsy now (anyway the doctor is not available until May to do it)? Please, let me know. Actually one more question: what is a lymphoproliferative disorder? Could you explain this as well?

Thank you.

Hello doctor,

1. Is it possible that this is a benign tumor?

2. If the tumor is malignant, could it be taken by surgery? What would be the usual procedure with such a tumor and is the treatment working?

3. BCL1 and BCL6 would be positive in diffuse lymphoma, but my markers are BCL 2 (not 1) and BCL 6 and CD10. The cytological report also says they can not distinguish between reactive lymphoid follicular hyperplasia and low-grade B-cell lymphoma, not DIFFUSE lymphoma. So the questions here are 2:

4. Is it still possible that I have reactive lymphoid follicular hyperplasia which is not malignant?

5. Why do you say diffuse lymphoma and the report talk about low-grade lymphoma?

6. What is the treatment for both low-grade and diffuse? Since I don't have other symptoms, I feel totally fine and I am 34 is my outcome still positive?

7. Why would the biochemical markers get better, including the IL2 becoming lower and the echo showing not tumor-like if it is a malignant tumor?

Please respond to my questions above.

Thank you.