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What Causes Excessive Swollen Lymph Nodes In Abdomen?

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Posted on Mon, 5 May 2014
Question: In October 2013 my son was very sick his ct found a cluster of lymph nodes in his mediastinal wall and one node in his right lung. His wbc were 4.01 and RBC were 3.5 Uric acid was 9, AFP Tumor marker was <2.0 and his sed rate was 29 as well as his CRP 1.3, Bun was 5. His ct scans showed fatty infiltration of the liver and hepatosplenomegaly. They first thought he had lymphoma, but an infectious disease dr said no it was histoplasmosis. He went through three months of sporonox and his histo is all negative which by the way barely showed a positive in his urine, and never grew the histo fungus during a biopsy, he recently became sick again. After an ultrasound a week ago it showed his spleen was 7.5cm x 16cm. The splenic parenchyma is mildy hetergenous in echotexture. Centrally in the spleen there is a small geographically defined area of diminished echotexture measuring 13mm x 11mm. No fluid collection or ascribes seen. He is now being sent for a Pet Scan tomorrow. Can you tell me if the drs or radiologists believe they missed the correct diagnosis of lymphoma the first time? Also he now has streaky opacities in his right middle lobe due to scarring or atelectasis. He also has over 50 swollen lymph nodes in his abdomen. I have never heard of histoplasmosis doing any of this and he never presented with the general symptoms. He has the night sweats terribly, has coughed up blood not all the time, runs fevers but not daily, has the chills, he lost 30 pounds but gained that back and now that he is sick again is starting to lose weight again. He feels his stomache is constantly bloated the minute he tries to eat. I should also let you know he has constant bowel trouble. He cannot go to the bathroom without miralax. My gut really feels they missed the mark the first time and now instead of two lymph node mass areas he now has over 50 and his spleen is once again swollen but now has a new mass which was never there and his histoplasmosis came back negative.
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Answered by Dr. Dr.Raju.A.T (33 hours later)
Brief Answer: It is essential to rule out Lymphoma Detailed Answer: Hi, Thanks for your query. Sorry for the delay in my response. I am medical doctor, an associate in Department of Oncology, working with an experienced Oncologist. I answer on his behalf. Based on the symptoms and presentation I suspect Lymphoma to be a definitive diagnosis. I would recommend a full scale investigation to rule out the same. You are right in saying, the symptoms in your son do not completely fit into the diagnosis of Histoplasmosis. Also the tests are negative. I would not say that the histoplasmosis is ruled out completely but it is essential to rule our lymphoma before its too late. My first recommendation would be a Lymph node biopsy of an easily accessible enlarged lymph node followed by FISH (fluorescence in situ hybridization) test and Immunophenotyping. This would surely help to rule out the diagnosis. Hope, I answered your query. Regards,
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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Dr.Raju.A.T

General & Family Physician

Practicing since :2008

Answered : 4903 Questions

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What Causes Excessive Swollen Lymph Nodes In Abdomen?

Brief Answer: It is essential to rule out Lymphoma Detailed Answer: Hi, Thanks for your query. Sorry for the delay in my response. I am medical doctor, an associate in Department of Oncology, working with an experienced Oncologist. I answer on his behalf. Based on the symptoms and presentation I suspect Lymphoma to be a definitive diagnosis. I would recommend a full scale investigation to rule out the same. You are right in saying, the symptoms in your son do not completely fit into the diagnosis of Histoplasmosis. Also the tests are negative. I would not say that the histoplasmosis is ruled out completely but it is essential to rule our lymphoma before its too late. My first recommendation would be a Lymph node biopsy of an easily accessible enlarged lymph node followed by FISH (fluorescence in situ hybridization) test and Immunophenotyping. This would surely help to rule out the diagnosis. Hope, I answered your query. Regards,