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Swollen lymphnode, negative for MALIGNANCY. What to do?

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23 yr old female, nothing major as far as medical history and overall in great health. 3 months ago noticed what I presumed was a swollen lymph node in my neck just under my jaw. Painless and hadn't been sick recently so I left it alone for a few weeks knowing that's most likely what doc would say to do anyways. A couple weeks later I started experiencing pain under my arms and neck node had grown slightly. A month after original symptom started I saw GP who referred me to ENT. ENT did CT guided FNA which resulted negative for malignancy. I had had three CBCs w/differential all about a week apart along this time frame and each of them showed between55% and 67% lymphocyte level. That was the only thing out of the norm the doctor said. I also tested negative for mono. Moved states and a few weeks after biopsy saw a new ENT in the new state I'm in. At this point now I had a lymph node on each side of my neck that were swollen. (Original one was larger. About a centimeter and a half the ENT said) he referred me to an Internist to get a full body workup. By this appointment it had now been 2 1/2 months from original symptom. During the physical she said everything looked great except for swollen lymph nodes. At this point there's still the two in my neck and a third one now swollen under one of my arms. Throughout this entire time I haven't been sick with even a cold once. NO other symptoms aside from these three lymph nodes and underarm pain. She ordered a bunch of blood work. All the STD related blood work came back normal/negative. And urine sample was normal. Blood work is below showing the labs normal range and then my number. With the EBV coming back positive for the past antigen she now is sending me to and infectious disease doctor. She felt like nothing major was wrong with my blood work aside from the EBV and a VIT D deficiency. She also noted that the EBV test contradicts my symptoms since I didn't test positive for active EBV but my symptoms are clearly progressing that that was strange. Again so now I'm off to an infectious disease doctor. This will again take a couple weeks before I see them. At this point I'm ready for an answer. My biggest concern (and I've brought it up) is could it be something more serious like lymphoma? I would hate to miss something major like that and it be taking so long to come to a conclusion. I understand the diagnostic process takes time but I'm ready for some answers. Thoughts on blood work, overall possible conditions, and tests I should request? Thanks in advance!

Sedimentation Rate-Westergren - LC 0 - 32 mm/hr 2

TSH - EXT 0.450 - 4.500 uIU/mL 1.880

Hemoglobin A1C - LC 4.8 - 5.6 % 5.4

WBC - LC 3.4 - 10.8 x10E3/uL 4.8
RBC - LC 3.77 - 5.28 x10E6/uL 4.49
Hemoglobin - LC 11.1 - 15.9 g/dL 12.9
Hematocrit - LC 34.0 - 46.6 % 39.2
MCV - LC 79 - 97 fL 87
MCH - LC 26.6 - 33.0 pg 28.7
MCHC - LC 31.5 - 35.7 g/dL 32.9
RDW - LC 12.3 - 15.4 % 13.7
Platelets - LC 150 - 379 x10E3/uL 206
Neutrophils - LC 46%
Lymphs - LC 45%
Monocytes - LC 7%
Eos - LC 2%
Basos - LC 0%
Neutrophils (Absolute) - LC 1.4 - 7.0 x10E3/uL 2.2
Lymphs (Absolute) - LC 0.7 - 3.1 x10E3/uL 2.2
Monocytes(Absolute) - LC 0.1 - 0.9 x10E3/uL 0.3
Eos (Absolute) - LC 0.0 - 0.4 x10E3/uL 0.1
Baso (Absolute) - LC 0.0 - 0.2 x10E3/uL 0.0
Immature Granulocytes - LC 0
Immature Grans (Abs) - LC 0.0 - 0.1 x10E3/uL 0.0

Glucose, Serum - LC 65 - 99 mg/dL 85
BUN - LC 6 - 20 mg/dL 12
Creatinine, Serum - LC 0.57 - 1.00 mg/dL 0.67
eGFR If NonAfricn Am - LC >59 mL/min/1.73 124
eGFR If Africn Am - LC >59 mL/min/1.73 143
BUN/Creatinine Ratio - LC 8 - 20 18
Sodium, Serum - LC 134 - 144 mmol/L 141
Potassium, Serum - LC 3.5 - 5.2 mmol/L 4.2
Chloride, Serum - LC 97 - 108 mmol/L 102
Carbon Dioxide, Total - LC 18 - 29 mmol/L 23
Calcium, Serum - LC 8.7 - 10.2 mg/dL 9.3
Protein, Total, Serum - LC 6.0 - 8.5 g/dL 7.2
Albumin 3.5 - 5.5 g/dL 4.8
Globulin, Total - LC 1.5 - 4.5 g/dL 2.4
A/G Ratio - LC 1.1 - 2.5 2.0
Bilirubin, Total - LC 0.0 - 1.2 mg/dL 0.3
Alkaline Phosphatase, S - LC 39 - 117 IU/L 80
AST (SGOT) - LC 0 - 40 IU/L 34
ALT (SGPT) - LC 0 - 32 IU/L 43

C-Reactive Protein, Quant - LC 0.0 - 4.9 mg/L 1.2

Albumin - LC 3.2 - 5.6 g/dL 3.9
Alpha-1-Globulin - LC 0.1 - 0.4 g/dL 0.2
Alpha-2-Globulin - LC 0.4 - 1.2 g/dL 0.6
Beta Globulin - LC 0.6 - 1.3 g/dL 1.2
Gamma Globulin - LC 0.5 - 1.6 g/dL 1.2
M-Spike - LC Not Observed g/dL Not Observed
Globulin, Total - LC 2.0 - 4.5 g/dL 3.3
A/G Ratio - LC 0.7 - 2.0 1.2

Vitamin D, 25-Hydroxy - LC 30.0 - 100.0 ng/mL 17.1

RPR - LC Non Reactive Non Reactive

EBV Ab VCA, IgM - LC 0.0 - 35.9 U/mL <36.0
Negative <36.0
Equivocal 36.0 - 43.9
Positive >43.9
EBV Early Antigen Ab, IgG - LC 0.0 - 8.9 U/mL <9.0
Negative < 9.0
Equivocal 9.0 - 10.9
Positive >10.9
EBV Ab VCA, IgG - LC 0.0 - 17.9 U/mL 39.5
Negative <18.0
Equivocal 18.0 - 21.9
Positive >21.9
EBV Nuclear Antigen Ab, IgG - LC 0.0 - 17.9 U/mL 308.0
Negative <18.0
Equivocal 18.0 - 21.9
Positive >21.9
Interpretation - LC Comment
EBV Interpretation Chart
Interpretation EBV-IgM EA(D)-IgG VCA-IgG EBNA-IgG
EBV Seronegative - - - -
Early Phase + - - -
Acute Primary + +or- + -
Infection
Convalescence/Past - +or- + +
Infection
Reactivated +or- + + +
Infection
+ Antibody Present - Antibody Absent


Category: Internal Medicine Specialist

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Dr. Deepu Sebin Sebastian is online now

Expert:  Dr. Deepu Sebin Sebastian replied 4 Days.

Hello,
Thank you for your query at DoctorSpring.com
I understand your concern.
Your blood work indeed looks great apart from the EBV VCA and EBV NA positive. It seems like you suffered a subclinical mono, or the mono affected you in the past and got reactivated. Since FNAC was done, and it was negative for malignancy, it is conclusive that malignancy is completely ruled out. Yes, the mono results are slightly confusing, but I would not really bother much about the lymph nodes without any symptoms. These are reactive lymph nodes, that can arise due to subclinical viral infections and resolve on their own spontaneously. I will advise you to repeat the Mono tests after a month, and also get the lymph nodes clinically examined.
Hope this was helpful,
Feel free to discuss further.


Dr. Deepu Sebin Sebastian
Category: Select Speciality
Experience: 
MD, Internal Medicine - Stanley Medical School
Medical School - MBBS - Govt. Medical College, Kottyaam

Diagnostic Prediction - Stanford School of Medicine
Received Specialty training in Critical Care, Cardiology, Neurology, Gastroenterology, Nephrology from Stanley Medical College and in Endocrinology, Rheumatology.

Hematology and Geriatrics from Madras Medical College.
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