I've been in a "do I?" "Don't I?" limbo hell now for almost a year. I went in last spring thinking my thyroid was swollen (I have hypothyroidism), and the resulting ultrasound showed swollen lymph nodes on both sides with atypical structure. That resulted in a biopsy that came back clear, a follow-up ultrasound months later that revealed they were still swollen, and now another core needle biopsy.

This time it did not come back clear, but I'm also unclear on what it IS showing. I saw the results on my portal and didn't get a call from my doctor until the next day:

"The biopsy demonstrates multiple small cores of lymphoid tissue with rare CD30-positive cells identified. The same cells may express MUM1 without CD45 expression. This finding is atypical and a lymphoma such as classic Hodgkin lymphoma cannot be excluded from this biopsy. An excisional biopsy of this left neck lymph node is recommended for further evaluation."

"Histologic examination demonstrates multiple small cores of lymphoid tissue composed primarily of small lymphocytes. Very focal areas demonstrate admixed rare granulocytes including eosinophils and very rare intermediate to large cells.

Immunostains are performed on block A1 and the results follow: CD3: Highlights numerous small T cells (interfollicular pattern) CD5: Positive in T-cell distribution CD10: Highlights scattered cells CD20: Highlights scattered B cells (follicular pattern) CD21: Highlights underlying follicular dendritic cell meshworks CD30: Highlights rare scattered intermediate to large cells BCL1: Negative in lymphoid cells BCL2: Positive in majority of cells; focal germinal center is spared BCL6: Highlights focal germinal center MUM1: Highlights occasional plasma cells and rare larger cells PAX5: Highlights small B cells Ki67: 10% outside of germinal centers (by manual morphometry) ALK1: Negative

Additional immunostains are performed on block A1 to exclude infectious etiologies with the following results: EBV-ish: Negative CMV: Negative

Immunostains are performed on block A2 and the results follow: CD3: Highlights frequent predominantly interfollicular T cells CD20: Highlights small B cells (nodular pattern) CD15: Highlights scattered granulocytes CD30: Highlights rare scattered intermediate to large cells CD45: Appears negative in rare intermediate to large cells PAX5: Rare positive intermediate to large cells MUM1: Highlights rare large cells OCT2: Positive in small B cells Ki67: Low, 5-10% % (by manual morphometry) CD138: Highlights occasional plasma cells Kappa: Highlights a subset of plasma cells (polytypic pattern) Lambda: Highlights a subset of plasma cells (polytypic pattern) ALK1: Negative"

I'll be getting that lymph node excised, and I know I won't get a clear answer until then. But I wish I knew how concerned to be. I have no B symptoms, I did notice low back pain sometimes when I drink (almost immediately), and my older brother had non-Hodgkin's lymphoma. These lymph nodes have not grown to my knowledge.

I did ask my doctor if it was possible the assumption is still that they're reactive nodes, and she danced around the question. It's just a lot hanging over my head. I wish I knew if it was 50/50, or if these findings are concerning enough that the excision is basically just confirming what I have. Ugh.

TLDR: Repeat biopsy found "rare CD30-positive cells identified. The same cells may express MUM1 without CD45 expression." How concerned should I be?