Hello doctor, I was in a car accident four years back. After one week while I was having bath, I felt one small lymph node in my left neck. I did not feel it before. It was little bigger that time. By the time it is getting smaller but not going to its original size. I cannot see it now but I can feel it. So, I am worried and popping it all the time. Recently, I found one gland in floor of the mouth in left side and it is very small and not growing in size. Sometimes I feel swelling in left side of mouth and left leg. I got no night sweat, no fever and no weight loss at all. I got five small petechiae (red blood spots) in right chest. I have attached my complete blood test history for three months. Symptoms: Constant left shoulder pain, bone pain, hand pain. extreme fatigue, and tiredness. I feel something struck in throat. Bowel habit change. Medications: Doxycycline Hyclate 100 mg for two weeks. Amoxycillin 500 mg for one week. My questions to you are as follows: 1. Do I have lymphoma or leukemia? 2. If your answer of no. 1. is no, then why the lymph nodes are not going back to their original size after completing whole antibiotic dosage? 3. Why my WBC and lymph % are fluctuating too much? 4. Can lymphoma be ruled out from CBC test? 5. What is your opinion about my blood report?
Hi. Based on your query, my opinion is as follows:  No, it is neither lymphoma nor leukemia. There is no cell predominance (either neutrophil or lymphocyte or any immature cells) or the counts are also not high enough to think of leukemia. Lymphoma lymph nodes are usually multiple and do not regress in size. Lymph nodes usually take longer to regress and sometimes, mild infection in the location could be making it to be active. It could also be chronic lymphadenitis, with variable amount of fibrosis inside it, due to which, it may not regress back to its original size. If it was lymphoma, it would be increasing and multiple sites and multiple nodes together would be enlarged. WBC are cells related to fighting infections and inflammations. As the body is fighting some infection or other in everything (food, water, air, etc.), it will vary. Also, stress and hormonal variations can affect it too. If the count is not shooting excessively over the normal range, not to worry. No, usually lymphoma cannot be ruled out from CBC test. Fine needle aspiration cytology of lymph node or biopsy of lymph node is essential. However, at present, it will not be essential looking at small lymph nodes. Blood report, overall is good. Mild neutrophil increase, indicating possible mild infection or stress. Stress could be responsible for all the symptoms at present. Nothing in the blood report, can explain the symptoms you have. Check calcium level once. As the platelet count is normal and you do not have any bleeding, petechiae could be due to small pressure spots. It will disappear. Not to worry about it. If it starts occurring at multiple spots, then prothrombin and activated partial thromboplastin time evaluation may be necessary.