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Morphologically normal enlarged LYMPHNODES in biopsy. Means?

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In March 2015 I went to my general doctor. She felt an enlarged lymph node in my left armpit (I couldn't feel it). She sent me to radiology on 3/31 for an ultrasound. The ultrasound showed 4 enlarged lymph nodes measuring 1.8 x 2.1 x 1.1 cm; 1.9 x 0.9 x 1.4 cm; 1.4 x 1.1 x 0.8 cm & 1.5 x 1.8 x 0.7 cm. When report came back to my GP, she referred me to a general surgeon for 2nd opinion. General surgeon sent me for a needle biopsy on 4/21/15. The path report stated, "A) lymph node, left axilla, ultrasound guided needed core biopsy -- PREDOMINANTLY BLOOD WITH SCANT FIBROADIPOSE TISSUE AND SMALL COLLECTION OF LYMPHOCYTES CONSISTENT WITH A SMALL FRAGMENT OF LYMPH NODE. COMMENT: There is no evidence of malignancy in the biopsy; however, the amount of tissue is somewhat scant. The collection of lymphoctyes measures 1.5 mm. Correlation with the radiographic and clinical findings is essential as to whether this is representative of the clinically described lesion. Based on this, surgeon decided to re ultrasound the area in 2 months. I went back on 6/8/15 for follow up ultrasound. Report stated, "conclusion: PROMINENT LEFT AXILLARY LYMPH NODES ARE GROSSLY STABLE SINCE MARCH 2015. MASSES: Multiple prominent left axillary lymph nodes are overall similar in appearance and size to the prior study from March 2015. One of the lymph nodes measures 2.2 x 1.2 cm, previously 2.1 x 1.1 cm. A second node measure 2.5 x 0.8 cm, previously 2.3 x 0.7 cm. Based on this, surgeon decided to perform surgery to take out a lymph node on 6/19/15. I went to surgery (open incision, general anesthesia). While in recovery, surgeon came out & informed my husband that she took out "2 maybe 3 nodes" told my husband they were "squishy" so not to worry. My instructions were to rest over the weekend and return to work on Monday. Monday rolled around and I was in extreme pain. I went back to see the surgeon's nurse on Tuesday, 6/23. She checked my incision that day (the nurse). Meanwhile, the surgeon called me & said that she took out a "tremendous amount of tissue". She told me it looked fine. I asked her if they checked the nodes for anything else (infection, autoimmune disease, etc...) that is when she told me that they did not because they didn't see a lymph node. So, basically I was given surgery as if I had breast cancer but with no lymph nodes identified. I obtained a copy of the path report from the surgery. This is what it says "GROSS DESCRIPTION: Received in formalin labeled with the patient's name and "LEFT AXILLARY LYMPH NODES" this specimen consists of multiple fragments of fat ranging from 3 to approximately 0.5 cm and aggregating 8 X 5 X 1.5 cm. Dissection shows not grossly evident lymph nodes or other specific lesions. Represented in 2 cassettes. MICROSCOPIC DIAGNOSIS: A) Soft tissue, left axilla, excision - BENIGN FIBROADIPOSE TISSUE - NO LYMPH NODES IDENTIFIED. In the meantime, I obtained the Op Report and it clearly states that she saw 2 large lymph nodes with the ultrasound and removed them, passed them off for pathology. My question is this: Does the path report mean the lymph nodes she thinks she got out were not there? I have asked the surgeon. She said "maybe they were lost in the fat". I am now at a loss as to what happened to the lymph nodes. I went in to get another ultrasound (ordered by my general doctor) on 6/29/15. It was a hard ultrasound to do because I was swollen with 2 seromas, but what they could see says this: "STABLE APPEARANCE OF MORPHOLOGICALLY NORMAL AND MINIMALLY ENLARGED LEFT AXILLARY LEVEL 1 LYMPH NODE. A TWO COMPONENT SEROMA IS NOW PRESENT IN THE POSTOPERATIVE SETTING, LARGEST PORITON LOCATED SUPERFICIALLY, 4.9 X 4.0 X 2.2 CM IN SIZE. There is a slightly normal lymph node suggested within the adipose tissue of the left axilla, 2.8 x 1.1 x 1 point cm. It also goes on to state the 2nd seroma size (2.0 x 1.7 cm in short axes by approx. 2.3 cm in length. ----- I have all reports if necessary to attach them later. I have now developed "cording". It's very painful. What is your suggestion? I'm not sure what the path report means, did they not see the lymph nodes? Are they still there and were possibly not visible because of the seromas? I have asked questions to the surgeon, but answers are vague. I had my seroma drained by her, but it was because my general doctor had to call her to tell her to help me. She is now on maternity leave. I consulted with another surgeon, he said he will follow up with me in 3 months and showed me some exercises to do to help with the cording that developed. I have a history of lymphoma (sister and aunt). A different sister does have breast cancer now. I am not thinking I have cancer, but without a proper biopsy (because the lymph nodes weren't there) I am not sure why my lymph nodes are enlarged. I'm very confused. I am a 49 year old female. thank you

Category: Oncologist

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Category: Hematologist
 30 Doctors Online

Thank you for your query at
Your clinical scenario looks more like a benign disorder. Without a proper biopsy evidence, malignancy cannot be ascertained.
I would suggest if you could ask for a second pathology opinion if needed. A follow up scan of the axilla may be done at monthly basis to check for resolution of the swelling.
I would suggest you to continue physiotherapy and other remedial measures for improving your symptoms.

Patient replied :

thanks for your reply - I do have a follow up question. From what the path report says "no lymph nodes indentified", does that mean there was just fat or would there be lymph nodes in there but not the lymph nodes she thought she got? Also, how would one know if he sentinal lymph node was removed. The part that has confused me is that I have developed the cording which is a complication from breast cancer surgery. Wouldn't the cording only happen if lymph nodes were removed, or could that still happen if just soft tissue was taken out? Again, when asking the surgeon, her answers are very vague. Would you have recommended surgery based on the info I gave you? Not sure if I should get blood work and would a MRI help?
I attached the OP report - i think it worked correctly. thank you

Usually lymph nodes are embedded in adipose tissue. A very careful dissection is required to separate nodes from fat. Sometimes wen the nodes are so small, there are chances of being missed. The exact reason of your unseemingly benign path report is difficult to comment.
However, a MRI is not needed now. I would suggest you to do physiotherapy and follow up in few weeks' time.

Dr. Prasad Eswaran
Category: Hematologist
Doctorate in Medicine (Fellowship in Oncology), DM,  Madras Medical College & Govt. General Hospital, Chennai, India.

Doctor of Medicine (Residency in Radiation Oncology) , MD, Christian Medical College, Vellore, Tamilnadu, India, 2004-06.

Diploma in Medical Radiology & Therapy (Residency in Radiation Oncology), D.M.R.T, Madras Medical College & Govt. General Hospital, Chennai, India, 2004-06.

Bachelor of Medicine & Bachelor of Surgery - M.B.B.S, Govt. Stanley Medical College & Hospital, Chennai, India, 1998-2004.
Dr. Prasad Eswaran and 4 other Medical Specialists are ready to help you

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