OpenHealth Q&A

Seeking Guidance on a Persistent Mass near the Left Parotid Region

I am a 25-year-old female, 5'1" tall and weighing 170 pounds, currently six months postpartum. A brief overview of the situation: In mid-December, I discovered a small lump about the size of a pea situated in front of my left earlobe where my jawbone connects. I promptly made an appointment with my primary care physician (PCP). My PCP was particularly concerned about the possibility of a tumor in the parotid gland. Blood tests returned within normal limits except for mild anemia, which led to a recommendation for iron supplements. Subsequently, I was referred for an ultrasound. The ultrasound results indicated the following: • An enlarged lymph node measuring 2.1 x 1.2 x 1 cm with thickened cortex, alongside another abnormal lymph node sized 1.2 x 1 x 0.9 cm, which exhibited no fatty hilum. • The impression from the ultrasound was inconclusive; both lymph nodes were located in the left parotid area, and a CT scan with contrast was advised for a more detailed assessment. I proceeded to undergo the CT scan with contrast, revealing an enlarged lymph node or mass within the left parotid gland along with a borderline enlarged lymph node at Level 2. It was recommended that I consult an ENT specialist. After my initial visit to the ENT, I was scheduled for an ultrasound-guided biopsy accompanied by flow cytometry. The findings from these tests were as follows: • Flow Cytometry: The samples revealed mature B cells along with a mix of T cells; however, no notable abnormalities were detected. • Biopsy: The specimen obtained was limited and appeared crushed, containing mature lymphocytes; there were no signs of a lymphoproliferative disorder, yet the findings were insufficient to reach a definitive conclusion. An excisional biopsy was suggested should the lymphadenopathy continue. Unfortunately, the results from the biopsy did not provide clarity, leading to a referral for another CT scan approximately six weeks after the initial one. The findings were comparable to the previous CT scan, displaying two soft tissue density lesions in the superficial area of the left parotid gland, with a slight reduction in size of one of them. (Interestingly, the recent CT results were compared only to the prior ultrasound, which could explain the noted decrease in size due to differences in imaging techniques—I'm unsure why they did not compare it to the earlier CT results.) The summary suggested that the observed lesions could be enlarged intraparotid lymph nodes, although other potential causes remain a possibility. As of today, March 18, 2025, my follow-up with the ENT provided me with two options: adopt a "watchful waiting" approach with a repeat scan in four months or opt for surgical removal of the mass/lymph nodes for a definitive diagnosis. Frankly, I am uncertain about my next steps. It has been four months since I first detected this lump, which now feels firmer and larger, almost the size of a grape instead of a pea (though I might be exaggerating). There is no pain associated with it, but I am anxious because it seems to be persisting, and the uncertainty is quite distressing. During the appointment, my ENT inquired about symptoms such as fever, unexplained weight loss, and night sweats. I have been experiencing persistent night sweats, which I attribute to being six months postpartum and breastfeeding. I'm reaching out for any advice or insights regarding what this lump may signify. Should I consider surgery at this point, or would it be wiser to monitor the situation? The thought of surgery is alarming, especially as I have a six-month-old, and I want to avoid unnecessary procedures, yet I also desire a comprehensive pathology report on whatever this might be. Thank you in advance for your help!

Answers (1)

3/19/2025, 2:20:46 AM

OpenHealth AI

Opening Statement: It’s understandable to feel anxious about a persistent lump, especially with the ongoing uncertainty and the recent changes in its size. You have two viable options: watchful waiting or surgical intervention. Let's explore these in detail to help you make a decision that aligns with your priorities.

Explanation: The lump in your left parotid region, along with localized lymphadenopathy, raises legitimate concerns, particularly given your symptom of night sweats and the changes you’ve noted in size and firmness. While your biopsy results showed no definitive signs of a lymphoproliferative disorder, the inconclusive findings and persistent enlargement of the lump warrant careful consideration.

1. Watchful Waiting: This approach is often chosen when there’s low suspicion for malignancy and the patient is stable. It involves regular monitoring, which could lead to additional imaging to track any changes over time. This approach may be suitable given that:

   • You currently have no alarming symptoms such as fever, significant weight loss, or severe night sweats that could suggest a more serious underlying condition.
   • The slight reduction in size of the nodes noted on imaging might suggest the possibility of self-resolution.

2. Surgical Removal: This option may provide a clear diagnosis and peace of mind, especially if you're anxious about potential unknowns. It’s particularly advisable if the lump is growing or becoming symptomatic, or if the uncertainty is causing you significant distress. Considerations for surgery include:

   • The ability to obtain a comprehensive pathology report, which could clarify the nature of the lesions.
   • The potential for a more definitive treatment plan based on the findings from the surgery.

Next Steps:

1. Assess Your Symptoms: Reflect on any changes in your health since the last check-up—this includes monitoring for fever, weight changes, or new symptoms. If any concerning symptoms arise, it may influence your decision towards surgery.

2. Consultation and Questions: Prepare a list of questions for your ENT specialist during your next visit. This can include:

   • Clarification on the risks and benefits of surgery vs. watchful waiting.
   • Inquire about the likelihood of the lump being benign vs. malignant based on your imaging and biopsy findings.
   • Discussing your concerns about recovery time and how it may impact your responsibilities as a new parent.

3. Decision Making: Ultimately, you should weigh how much uncertainty you are willing to live with versus your desire for definitive answers. If anxiety about the lump is significantly impacting your well-being, surgery might be more favorable.

4. Support Systems: Engage your partner or close friends for emotional support during this time. This can help you process your feelings and make informed choices.

Remember, whatever choice you make, it's important to feel comfortable and confident in that decision. I’m here to help clarify any further questions you may have as you consider your options.