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This question was answered on Fri 10, Jul 2009 12:53pm by K S Saini, MD, MRCP (UK), DM

lump near thymus and high lymph count


    
Asked by aprilg (Female; 29; POTS, Celiac and possible fibromyalgia ; Relevant drugs:protonix, ambiem, pamelor and fludrocortisone ) on Fri 10, Jul 2009 12:30pm
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I have a lump in my chest bone where the thymus is located. First was sent for two breast ultrasounds just to find out it’s too high to be the breast now I am being told it could be an extra rib bone forming. I have had a chest x-ray that said a ct scan may be needed because the x-ray couldn’t detect the lump. I have felt really tired lately but am told it’s due to fibromyalgia and the pots (orthostatic tachycardia) condition I suddenly got last December. I have a problem with my labs showing a slow increase of my lymph count, and my white blood count is now almost past the normal range but falls just below the high marker. However my lymph count is high and is higher than it was last summer when the lump developed. The doctor said that some people run high lymph count and I would be dead if I were to have cancer for the past year, he also said that the rheumatologist I was referred to could answer why the lymph count is high. Unfortunately the rheumatologist said a high lymph count goes against any diagnoses she would be able to make and it’s not her field but is sending me for a nuclear bone scan next week to see of that detects the tiredness lump in the chest and the muscle pain. My question to you, is it true the cancer would have already spread so fast that I would be dead if I were to have cancer for a year or could it be a slow progressive one? Also will the bone scan be able to detect any tumors or will it only pick up bone cancer? And my last question is should I let this all be or should I find a specialist who can actually tell me what that lump is and why my blood work is off, does this all sound bizarre enough to peruse? Please help me I am tired of feeling bad and tired of feeling like I am being pushed off.
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Answer by K S Saini, MD, MRCP (UK), DM  on Fri 10, Jul 2009 12:53pm:

Hi, With a total WBC count in the high-normal range, a mildly elevated lymphocyte count, and relatively stable symptoms spread over a year, you certainly do not have any classic features of cancer. It is important to determine what the sternal lump is. For this, a CT scan may be a good initial investigation. A bone scan may add to the clinical information on the lump. High lymph counts and tiredness may be due to many causes. These include some infective causes (like tuberculosis) as well as rheumatological disorders. The answer to your first question is that it is theoretically possible to have a low grade lymphoid malignancy that takes many months to evolve. However, there is no specific reason to suspect this in your case. The answer to your second question is that a bone scan can pick up bone cancer, as well as cancers that began in other organs but later spread to the bone. And the answer to your last question is that you must seek an appointment with a good internist, and even a medical oncologist, so that you can reach the correct diagnosis and begin appropriate treatment. All the best, and God Bless!

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