Ask a doctor on the topic of Internal medicine

Swelling of lymph nodes due to EBV or melanoma???

June 30, 2013 | 15,00 EUR | answered by Dr. med. Frauke Gehring

My husband has been a melanoma patient for a year (SSM TD 0.97mm CL 4). Everything was fine until now! In February of this year, I noticed a swollen lymph node a few centimeters away from the melanoma. The ultrasound showed that it was 18mm in size and relatively inconspicuous. A week later, he was diagnosed with EBV after having the flu for three weeks. Another small lymph node was also found but was never really noticed. Ultrasounds were done every 4 weeks and one CT scan. The lymph node appeared normal at 15mm, then 12mm, and now 13mm. Last Thursday, because I couldn't shake off my worries, we went back to the hospital and were told that it looked suspicious. It completely threw me off. They said that the blood flow to the lymph node was pushed to the edge and the core was not clearly delineated from the rest. I am just crying all the time... my husband is only 36 years old and we have two young children, this can't be happening!

The report from 15.04.13 states:
Ultrasound:
On the left side of the neck, there is a well-defined subcutaneous mass measuring 14.1x9.7x5mm with an echogenic center pushed towards the edge and a widened echo-free margin on one side. Recommendation for CT scan!

CT:
On both sides submandibularly, along the vascular nerve strand (upper jugular group), and deep cervical, there are individual lymph nodes up to 15mm in size (exemplarily on the left upper jugular group, beginning to enlarge).

Report from 27.06.2013:
Behind the left sternocleidomastoid muscle, two superficial, hypoechoic, round, easily movable masses can be felt! Approximately 13mm in size!

These were removed on 28.06.2013 and shown to me. The doctor said they looked inconspicuous from the outside...

My questions would be:
1. Can blood flow be pushed to the edge due to an infection like EBV?
2. Can the core be clearly delineated in an ultrasound, and if so, could this be a result of EBV?
3. Shouldn't the lymph node actually grow in case of metastasis (this one shrunk)?

I would appreciate a response!

Regards, Nicole

Dr. med. Frauke Gehring

Good evening,

I am happy to respond to you.

First of all, lymph node enlargement in the neck area is quite normal in an EBV infection. A rim and a center pushed to the edge can also occur in benign conditions such as EBV.

There is no "core" that needs to be delineated. The center is not always exactly in the middle. In ultrasound, the lymph node can be clearly delineated, which is a good sign.

The last question is the only important one, and yes: a melanoma metastasis would more likely grow, while a lymph node inflamed by EBV would shrink over time. Since the lymph nodes were easily movable during the examination, I would be optimistic. Malignant nodes are usually adhered to the surrounding tissue and cannot be moved.

So please do not cry anymore!

Warm regards,
Dr. Höllering, Specialist in Internal and General Medicine