Malignant lymphoma? do I need nuclear scan or beta-2-microglobulin test?

Question

I'm a 25 yrs old male with no other health problems except for the last 5,6 months. Recently, starting 5,6 weeks ago I began developing mild to moderate pains(more like a pressure feeling) in the axillary and groin regions on both sides of the body. I've become also more fatigued than usual in the last months. All blood tests (including CBC, ESR, electrolytes, biochemistry panel, electrophoresis, viral serologies, including Hiv-ve), chest X-ray,ultrasounds,were in the normal ranges except for a mild eosinophilia (very likely parasitic related). 6 weeks ago I was tested also for toxo which proved to be mild positive ( ELISA IgM=0.65>0.45=reference, IgG=1.34>0.55). My questions are:

1)All these symptoms may be due to this toxoplasmosis (which based on Ig seems to have occured rather in the past) or to an undergoing lymphoma ?

  1. If it would be malignant lymphoma, wouldn't it show other changes on these blood tests?

  2. Would you recommend other tests (including a beta 2 microglobulin - I heard it is lymphoma marker), or a nuclear scan?

Thank you so much in advance for your answer which will be greatly appreciated, Daniel

Answer

Dear Daniel, Nothing in your query suggests to me that you have lymphoma. There are many causes of lymph nodes other than lymphoma. The most common cause of enlarged lymph nodes is when they enlarge to fight off an infection (such lymph nodes are called reactive nodes). A biopsy should be performed if one lymph node is out or proportion to the other lymph nodes, if you have systemic symptoms (fever, chills, night sweats, weight loss), or if they continue to grow. Nothing in your query sounds too worrisome.

In terms of your questions about beta-2-microglobulin and nuclear scans, neither test is indicated based on what you have written. The best test to look for lymphoma is a CT scan of your chest and abdomen, but based on what you have written, I doubt that even a CT scan is indicated. I would recommend that you see your health care provider and (s)he can follow-up and get an idea as to whether your symptoms are progressive over time; If so, the progression of symptoms will guide him(her) to the next step in your diagnostic work-up. BD.