HomeAnswersMedical oncologytuberculosisKindly clear my doubts regarding my lymph node enlargement.

Is the doctor correct in taking biopsy from only one area of lymph node?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

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Published At January 23, 2018
Reviewed AtFebruary 8, 2024

Patient's Query

Hello doctor,

I am a 31-year-old male. I have a neck swelling (lump in my neck) in the posterior triangle area for a few weeks. X-ray chest and USG whole abdomen are clear. I went to the doctor and done FNAC which showed reactive lymphoid hyperplasia and started Augmentin antibiotic and later Ceftum antibiotic but no resolution. Finally, excision biopsy was suggested and done. The report showed tubercular lymphadenitis and started the treatment and currently on Akurit four tablets for three days. Now, my question is, I had neck swelling in two areas of my neck as shown in the picture sent to you pointing out with my fingers. The upper one was large hard and lower one was small movable. ENT oncosurgeon said he will bring out lymph nodes from upper area and not from the lower side as it belongs to the same area.

Accordingly, excision was done and four lymph nodes from the upper area were sent to histopathology. In the meantime, while waiting for results my lower node grew in size a bit and also I felt lump just below my incision site. I mean lump type. And two days later, the report came and it was TB. Now, my question is:

Is the doctor correct in bringing out upper lymph nodes and not the lower area node? Could it be like lymph node swelling in the upper area was due to TB and lower area swelling for some other reason? Like lymphoma, etc.? What do you think? Your expert suggestion is needed. Does lymph TB involve single node or can be multiple in different adjacent areas?

Hello,

Welcome to icliniq.com.

Tuberculosis can present with single or multiple enlarged neck nodes. It is unlikely that one lymph node will be due to lymphoma and another due to tuberculosis.

Your doctor did the right thing by taking a biopsy from one area of lymph node only. No need to take from all neck nodes. Your X-ray chest and ultrasound are normal.

While in lymphoma, there may be associated abdominal, axillary, and mediastinal lymph nodes (central chest nodes) plus sometimes enlarged spleen and high LDH blood test, your ultrasound, and X-ray chest are normal.

In TB, usually ESR (blood test) is raised and skin test (Mantoux test) may be positive. Your neck lymph node FNAC or biopsy is clearly showing tubercular lymphadenitis.

Nothing to worry about and continue anti TB treatment and take balanced diet. All your lymph nodes will start disappearing in two to three months. Follow up regularly with your primary physician.

Patient's Query

Hello doctor,

I have a few more queries:

Since I am on Akurit-4 and will be on antibiotics for long so to help my liver can I take Silymarin tonic to reduce the toxicity of liver or any tonic you would like to suggest for liver protection?

My prostrate measures 28×28×26 mm and weight is 11 g. Is it normal? Why do I need to get up more to pee more at night? I do not have diabetes. Fasting 90 mg/dL HbA1c 4.8.

Is histopathology exam of lymph node, that is, excision biopsy which I did is accurate? Can it be some other not TB? How to confirm? I have the slide with me. If I send it for IHC is it confirmatory?

Hello,

Welcome back to icliniq.com.

The prostate size is little bigger. That may be the reason behind frequent urination at night. You should consult a urologist for the same. It may be prostatitis or benign prostatic hyperplasia.

Histopath report is accurate. No need to confirm again or do IHC. Regarding drug toxicity, your primary physician will monitor your liver for any drug-induced toxicity and he may check your liver function test intermittently. Usually, young people tolerate the drug easily.

No need to take Silymarin unless your physician will advise.

Patient's Query

Hello doctor,

I had undergone an excisional biopsy of my neck lymph node for histopathology, and it showed tubercular lymphadenitis. I had one or maybe two small nodes below the area of that node which was taken out for histopathology. The doctor did not take out all the nodes; he took out the biggest node in one area for histopathology. I had been on antitubercular medication Akurit 4 for exactly one month, but the node below the node taken out for biopsy has not yet disappeared. It is still there, and there is no regression. I am worried.

1) How long does it take for the nodes to disappear?

2) One doctor also said sometimes extrapulmonary TB nodes remain forever even after ATT treatment, but there is nothing to worry about. Is it so?

Hello,

Welcome back to icliniq.com.

There is nothing to worry about. Just continue anti-TB treatment as before and follow up with your physician. He will assess you clinically and serologically (blood tests) for the response to the treatment and monitor for any drug-induced toxicity. It may take time for lymph nodes to regress or disappear, usually 2 to 3 months or more. Yes, sometimes these lymph nodes may even persist for a long time. But I hope you are responding to the treatment and feel symptomatically better than before.

Only worry:

1. If symptoms worsen or new symptoms appear, for example, fever, cough, weight loss, sweating, abdominal distention and pain, and anemia.

2. Eruption of new lymph nodes or increase in the size of preexisting lymph nodes.

Patient's Query

Hello doctor,

1) No new symptoms, no fever, no weight loss, no sweating, and no abdominal pain have occurred. I just had a cough once or twice. I just wanted to know, in extrapulmonary TB, which is cervical TB, does a cough occur? Can the cough be for some other reason, like cold sinusitis, asthma bronchitis, etc., which I have?

2) No new node eruption has occurred, but the same old nodes are movable and of the same size. I heard histopathology, i.e., excisional biopsy is the gold standard for diagnosing TB lymphoma, which I did. If it does not regress, what could be the reason for the same? Is there any more accurate test available other than histopathology?

Hello,

Welcome back to icliniq.com.

In extrapulmonary tuberculosis, there is usually no cough. It can be due to many reasons, for example, chest, throat, sinus infections, allergies, bronchial asthma, and many other reasons. In case the cough persists for more than three weeks despite treatment for the underlying reason, an X-ray of the chest may be needed. Histopathology is the most reliable and gold standard test for malignancy and tubercular lymphadenitis. If the existing lymph nodes do not increase in size but persist for a long, long time, that means it is fibrosed (non-functional tissue) and not due to disease.

Patient's Query

Hello doctor,

1) Since I am on ATT for cervical TB, that means if I have TB bacteria anywhere else in the body, say lungs, or spine, whether it is latent or active, it will work for all, is it, or the TB treatment for different organs are different?

2) What can be done with fibrosed (non-functional tissue)?

3) How to know if I am drug resistant? What are the tests for it? What is the percentage of drug-resistant in general?

Hello,

Welcome back to icliniq.com.

Yes Anti TB drugs work for any kind of tuberculosis anywhere in the body. For fibrosed Lymph node nothing to be done usually. It will not harm you. It is very early to say to say whether fibrosed or not. Regarding resistance there are TB culture tests available to detect resistance. The anti TB drug percentage in India is 3 % in new cases or first time TB and 17 % for reinfection cases.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Arshad Hussain Shah
Dr. Arshad Hussain Shah

Medical oncology

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