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Loads of lymph nodes and Loads of questions about them
Jun 9, 2003

My boyfriend is about 3 yrs. positive, no meds ever, CD4 667, Load 14,570. He is healthy otherwise. His lymph nodes all over his body have been swollen but those in his neck are larger causing people to notice them. While seeing a surgeon about removing an unrelated cyst/ingrown hair on his neck the surgeon did an ultrasound on the glands and says they are 1.7 cm and are probably going to become a lymphoma.(how does he know that?) Of course we knew this may happen some day but truly weren't thinking we'd have to deal with that at this point, especially with his labs doing so well. He said if we wanted he could biopsy or remove them but we are thinking that isn't necessary but don't want to neglect a possible problem. These are my questions: 1) Should these be biopsied in case it is a lymphoma? 2) If they are removed couldn't the lymphoma show up somewhere else? 2) How easy is it to cure/treat HIV related lymphomas? 3) If it's not a lymphoma and the glands are removed anyway, are we removing something useful that was doing some good to fight the HIV? Or can we assume they are proliferated beyond usefulness. 4) What type of scar is left after this type of surgery?

Thank you for taking the time to answer all of my questions. .

Response from Dr. Dezube

Enlarged lymph nodes are an integral part of HIV disease. The enlarged lymph nodes represent the body's attempt to fight off HIV disease. Lymph nodes may be particularly prominent early on in HIV infection (e.g. when the CD4 count is 667). In many patients, the neck lymph nodes indeed can be quite noticeable. Most often these lymph nodes can be safely ignored (even if others can't ignore them).

On occasion, a lymph node can indeed become cancerous. There is no hard and firm rule as to when a lymph node needs to be biopsied. Situations, which particular worry me, are when one or two lymph nodes are way out of proportion to the other nodes, when a patient has systemic symptoms (fever, chills, night sweats, weight loss), when a set of lymph nodes keeps on progressing/growing. The biopsy of a lymph node is a relatively minor and safe procedure, so when in doubt, it does indeed pay to biopsy them. As for lymphoma, it often is quite treatable. This is the subject of other responses, which I have posted. Kindly refer to them. In the unlikely event that your boyfriend has lymphoma, please write back to me.


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