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benign lymph node removed would have continued to grow per surgeon

I had an excisional biopsy done yesterday-the doctor had a pathologist on site and told me and my husband that the lymph node (submandibular) was benign but it was good we got it out because it would have continued to grow but when I asked why it would have continued to grow he said lets just wait for pathology and we will go over it at your post up next week and start your thyroid work up. What would have made the node continue to grow if it was not malignant?
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  • Female | 25 years old
  • Medications: synthroid 150 mcg
  • Conditions: hashimotos thyroiditis

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Featured Answer

5 UpVoted this answer Erik Borncamp, MD General Surgeon, New Lenox
Lymph nodes are a normal part of the body. Their job is to help fight off infections. They will enlarge when there is an infection in the area as part of a response to the infection. For example, if you have a throat infection, the lymph nodes in your neck will enlarge and respond to the infection. In most cases, once the infection is gone the lymph nodes will shrink back down to their normal size, although with certain infections such as infectious mononucleosis (Mono) the lymph nodes can take many months to reduce in size.

Lymph nodes will also enlarge when they are involved in an inflammatory or autoimmune disease process, such as Sarcoidosis, when cancer has spread to them (eg. breast cancer) or when a cancer starts within them (lymphoma).

I am not sure why the surgeon told you the node would have continued to grow if it was benign. The only reason that would happen is if it is part of an ongoing process like cancer or autoimmune disease. It is true that the pathology report will give you a better idea of what is going on, but I am in agreement with Dr. Bose, who answered previously, that a fine needle biopsy would have been a better way to try to biopsy this node. An excisional biopsy is a last resort and should only be done instead of a needle biopsy when a needle biopsy is considered too dangerous ( which is very rare).

I would also agree that you should consider a second opinion from a Head and Neck Surgeon. The American Head and Neck Society is an organization for physicians who are involved in treating tumors of the head and neck region. There is an online listing of head and neck surgery specialists that you can review at the following web site:

http://www.ahns.info/ahns-public-member-profiles/

You can use the search form at the top of the page to find someone in your area. That would be a good place to start if you are seeking a second opinion.
Edward Gabalski
4 UpVoted this answer
Simple inflammation in oral cavity is another reason for growth of a lymph node without a cancer etiology
Cosme Manzarbeitia
2 UpVoted this answer
I agree with what has already been written.

1- Wait for the pathology report.

2 - The surgeon was justifying the procedure by saying the lymph node will continue to grow and by saying the lymph node was too mobile too aspirate.

3 - I still think FNA is very useful, although not quite 100% accurate. Mobile lymph nodes are a little more difficult to aspirate, but are still doable.

4 - Lymph nodes will only grow to a certain size if benign, reacting to antigen stimulus of an infectious or inflammatory process. Malignant nodes will continue to grow.

5- I would have an FNA done on the thyroid before undergoing any more surgery.
Stan G. Eilers
1 UpVoted this answer
A benign lymph node is not going to continue to grow.The pathology at the time of surgery is a fresh frozen biopsy and is not as complete comprehensive biopsy report. That is what he is waiting to discuss with you
Steven M. Stoller
1 UpVoted this answer
I agree with Dr Eilers's comments, particularly his recommendation that an FNA (fine needle aspiration) biopsy done on the thyroid before undergoing any more surgery.
Laurence Berg
1 UpVoted this answer
At this point I feel like the surgeon needed to justify the surgery, but lymph ode biopsies NEED to happen and good for us they are frequently benign, no cancer etc..

Wait for pathology do not over analyze.
Susan B. Young
1 UpVoted this answer
Agree with the other comments but to give the benefit of the doubt to the surgeon wait for the Pathology report.
Mohammad S. Amawi
1 UpVoted this answer
I am unaware of reasons why a presumably reactive lymph node "would have continued to grow". An excisional biopsy prior to a proper work up is unusual outside of a few circumstances. Ultrasound guided fine needle aspiration is the procedure of choice for enlarged nodules in the neck after a thorough workup has taken place. In the setting of thyroiditis, a more complete thyroid workup prior to a surgical excision would tend to help us work out whether we believe an enlarged node represents malignant disease, such as spread from a thyroid cancer. If this was the clinical suspicion and the full workup was available, the procedure of choice would be to remove your thyroid and perform an appropriate lymph node dissection. My advice would be to seek a second opinion from an experienced head and neck surgical oncologist.
Debashish Bose
Lymph nodes "grow " for many reasons but the main one is what's called reactive change This is a normal response of the lymph node to fight infection. It will usually go back down when the infection is gone. Other reasons such as cancer are much more rare. But more serious. Usually it is only the malignant nodes that continue to grow. The final path will tell you whether it was malignant or not.
Erik Borncamp
We had to do the excisional because he felt it was too mobile to get a FNA-I have some calcifications in my thyroid but he said we would do the thyroid work up after the removal of the lymph node because i had the lymph node for about 18 months and though it was happening slowly it was getting larger so after the CT he decided the only way we were going to get a definitive diagnosis was by the excisional biopsy-he said we were waiting for pathology to rule out anything 'weird'. I am not sure what all of that means but that is what he told me when he called this morning and that he would call today or tomorrow with pathology report even though I have a postop next week. I am not sure if they think there might be something more that they couldnt get in the OR with the pathologist or what but he definitely told us it was benign.
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