I Have 2 Enlarged Lymph Nodes

Question: hi,
I have 2 enlarged lymph nodes, one on each side of my neck, level 2, submandibular. One measures 1.7x2.4x.8cm and the other measures 3.5x2.5x.8cm.

They were first found on an MRI on Nov 2, 2020. The findings said: Incidental note is made of multiple lymph nodes within soft tissue neck with the largest one at
level 2 greater on the right side of unknown clinical significance and may be due to cervical
adenitis. The largest lymph node measures about 1.5 cm in diameter located medial to the
sternocleidomastoid muscle

Then, I had a neck ultrasound which said: Scanning was performed in the areaS of palpable abnormality bilaterally. Prominent elongated lymph
node is seen in the right measuring 3.5 x 2.5 x 0.8 cm. A prominent elongated lymph node is seen in
the left measuring 2.4 x 1.7 x 0.8 cm.

IMPRESSION: Palpable abnormalities correspond to elongated bilateral lymph nodes with normal
architecture.

After the MRI, my doctor said they wanted to do a biopsy to rule out lymphoma and that an ultrasound could not definitely tell us whether they were benign or malignant. After the ultrasound, they said I’m fine and there’s no need to do a biopsy.

The other symptoms I have are fatigue and some days I feel dizzy all day, but I have other inner ear problems that might be causing the dizziness. I also have an arachnoid cyst but I was evaluated by a neurosurgeon and they said not to worry about it but we are watching it to make sure it is stable.

So now I’m confused because my doctor said I need a biopsy to rule out lymphoma, but then they ruled out lymphoma without doing the biopsy. I’d really like a second opinion on this. I’m female, 27 years old.

Thanks for any help you can offer.

Thank you for your answer. So it is possible then to have a lymph node show "normal architecture" on an ultrasound and still be malignant? Also, is it possible then for the lymph nodes to be this size but not be cancerous? What are the odds of them being enlarged from a benign cause? I don't feel ill and the lymph nodes themselves are painless but moveable. It's also strange to me that they are this size but are not protruding very much. They're large but sort of flat. Does that happen with malignant nodes? I had a negative COVID test in October. No other serious symptoms really.

Hi again, did you mean that benign lymph nodes usually are painless and don’t protrude or malignant ones? Since your last response, I’ve had an appointment with a hematologist who did a physical examination and looked over my records and said there’s nothing that he thinks needs to be biopsied. He isn’t concerned about malignancy because I don’t have an enlarged spleen or any other symptoms. It has been my understanding that those kind of symptoms of lymphoma don’t occur until after the disease has spread to become stage 3 or 4, so I’d obviously want to rule out a malignancy before it reaches that point. I don’t necessarily think there’s definitely something wrong at this point, I just feel like there’s still too much uncertainty. Should I insist on the biopsy?