Chapter 9: Random Radiological Findings.

The lymph node in my right axilla was the only pertinent finding on my first set of surveillance scans. I was scheduled for an ultrasound guided biopsy the following week.

` I arrived at the center and after filling out all the usual forms once again I waited just a few minutes in the waiting area before going back for a mammogram. They insisted they had to do a mammogram before the biopsy and at that point I didn’t have the energy or the inclination to argue. The mammogram was finished. I was taken to another room where the biopsy would be done.

The sonographer was of course someone I knew. We talked about my bizarre cancer and how random some things in life are. She put some warm gel on the area under my arm and was quickly able to find the offending lymph node. I have never been able to feel it and still couldn’t when the biopsy was done.

The radiologist, Dr. Patel, was the same one who had diagnosed my Mother-in-law with breast cancer a couple of years before.

We were still in the throes of covid 19 and so everyone was masked up. He didn’t have a lot to say. A man of few words it would seem. He mumbled occasionally as he prepped and draped the area. He then inserted a needle a few inches down from my axilla and deep into the flesh on my right side. He was finished in short order and had prepared the biopsy for the lab. He then inserted another needle into the area and placed a marker so that they would be able to track the lymph node on future scans or ultrasounds to see if it was larger or smaller.

I thought we were through, so I headed for the door and was about to start getting dressed when the tech came back in and asked me to wait just a minute because the radiologist wanted another mammogram on that side to make sure the marker was in the right place.

"Simply smashing," I thought. Another Mammogram was just what I wanted.

The mammogram results showed. There are scattered fibro glandular densities that could obscure a lesion on mammography. There are no abnormal calcifications, architectural distortion or suspicious masses. Sonography will be performed for further evaluation.

There is an abnormal axillary lymph node with cortical thickening. The cortex measures approximately 7 mm in thickness.

No evidence of breast malignancy. Abnormal right axillary lymph node. Differential diagnosis includes infectious, inflammatory and malignant etiologies. In view of history of melanoma biopsy may be considered.

It was about seven days later that the results of the biopsy were put on my health app.

They read as follows:

Clinical History: Suspicious right axillary lymph node; history of melanoma.

Sonogram of the right axilla dated 7/20/2022. Two core biopsies specimens were obtained from an abnormal axillary lymph node using a 14 guage Bard biopsy device, clip placement following biopsy.

Benign lymph node with reactive follicular hyperplasia. Negative for malignancy.

Whew! The negative for malignancy allowed me to take a deep breath. A 14 guage needle was used? No wonder it hurt for a month afterwards.

The following notes about the biopsy read: There are follicle structures which are spaced out relatively evenly without a back-to-back configuration. Mantle zones are well formed. In order to better understand the biology of this lymph node a series of immunostains is performed. The control slides stain appropriately. The results are as follows.

CD20 follicle regions positive

CD3 Interfollicular regions positive

CD5 T-cell pattern

CD21 Follicles positive.

BCL-6 Germinal centers positive

CD10 Germinal centers positive

BCL-2 Germinal centers negative

Ki67 increased proliferation index in germinal centers.

Cyclin D1 Negative

Kappa Lambda (ISH) polyclonal distribution of lymphocytes and plasma cells.

EBER Negative

PD-1 Scattered positive cells.

Overall, the findings are that of a benign lymph node with reactive follicular hyperplasia. There is no evidence of Hodgkins lymphoma. There is no evidence of metastatic tumor.

For a negative biopsy that is a whole lot of positives in the detailed description. I dove right into researching what all of the findings meant. I thought Kappa Lambda was a sorority. Who knew?

I saw Dr. Anthony a few days later and he reiterated that the biopsy was negative, and we would just keep an eye on the enlarged lymph node with the future scans.

After it was all said and done, some 20 days after my scans, I had an all clear.

Deep breath in, and out. The bottom line is No Evidence of Disease! What we affectionately call NED.

When it comes to cancer and masses smaller is always better in my book.

I read on. No supraclavicular or mediastinal lymphadenopathy is present. Trace coronary artery calcifications are seen. A small sliding hiatal hernia is present. The lungs are clear. The traceable branches of the airway are patent. ACDF hardware occupies the neck base. A benign intravertebral hemangioma is seen within the T9 vertebral body.

What? A benign what? An intravertebral hemangioma is seen within the T9 vertebral body. OK. That was not there on the last scan. At least It wasn’t in the report for the last scan. It says it is benign. Benign means nothing to worry about.

So, why was I worrying about it. I’ll tell you why. I have had 2 previous CTs of the chest since my diagnosis and they never mentioned hemangioma. Is this something new then? Do I need to worry about this? Of course, I am going to worry about it. Any time one of these scans shows something that wasn’t in the previous scan, I worry.

I researched the hemangioma and found that they are nearly always benign. It also seemed that they didn’t just show up. They are usually there over a long period of time. Now the question was, Is it something new? I fretted about it for a couple of days. I went to medical records and requested a copy of all my scans on a disc. I took them home and was able to see the same area of hemangioma on the previous scans but apparently it wasn’t noteworthy to that radiologist.

All of this to point out the anxiety that accompanies these scans is extreme. I read and re-read the reports and blew things way out of proportion.

I reviewed the results with Dr. Anthony, I told him every 3-month scans are making me crazy. I asked him if he thought moving the scans to 6 months was unreasonable and he said it was up to me. I decided I needed at least 6 months before I get totally freaked out again.

Of the four sets of scans that were done in the first year after my diagnosis I noted that each one had been done at a different location. The scans are scheduled with one Health care system that owns several different locations. We ordered them in the same place. That didn't mean doing them all in the same place. Each had been read by a different radiologist.

I pondered the radiologists that I know. I believe they have an unspoken rivalry wherein they try to find something in the scan that the last radiologist didn’t see. Thus, every scan has some totally random finding that sends me spinning headlong into the vast universe that is our internet.

I always find some obscure Pub-Med article that sites a lone case of Ocular melanoma that metastasized to somewhere other than the liver, like a lymph node or the spine.

I know that fretting over the scans and the results is a waste of time and energy. But the knowledge doesn’t prevent me from freaking right out. Knowledge may be power, but it can certainly sap the joy out of life, when all you can think about is whether the cancer has landed somewhere new.

The last set of scans was in January of 2023. I am now fast approaching the 6-month scans and wonder what new and random tidbits we will find.

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