Further testing needed?

[Jerseywish2011]

I was diagnosed with CLL in August 2015, wait and watch. I was on mini vacation with my 21 year old son a few weeks ago and he turned his headed and I see a pea size lump in his neck. I ask him he knows it is there and he does not. When we get back I send him to a local GP by his college. The doctor thinks it is nothing but because of the new family history requests blood work and a chest xray to check for leukemia and lymphoma. Chest xray comes back clear (yay!!) And blood work come back ok except for high IGG and positive for epstein barr virus. Final diagnosis is past mononucleosis. My question is why would his IGG level be high and the lymph node/lump is still there after a month ( amd we don't know how long it has been there) and he has no symptoms of mono. Reading more about epstein barr and lymphoma/ leukemia there seems to be a link, maybe relatively small but it is there. I hope the doctor is right but think that further testing should or needs to be done. I am unsure of who to see or if I am just being a worry wart. Any suggestions from my CLL friends?

[AussieNeil Administrator]

As you appreciate, mononucleosis is caused by the Epstein Barr virus:

en.wikipedia.org/wiki/Epste...

Your son's high IgG result, positive for Epstein Barr virus shows that his immune system is working perfectly. B-Lymphocytes (B-cells) are the key part of our adaptive immune system: en.wikipedia.org/wiki/Adapt... Naive B-cells are assisted by helper T-cells to develop unique B-cell receptors for a pathogen, which in your son's case would be part of the Epstein Barr virus coat. (B-cell receptors incorporate an immunoglobulin keyed to a unique protein sequence on a pathogen (called an antigen) to make a special 'lock'. When that 'lock' is engaged by the antigen key, it triggers B-cell division.) This process takes about two weeks with the end result being a mass of clonal B-cells which mature into plasma cells all churning out identical antibody/immunoglobulins that latch onto Epstein Barr virus particles, marking them for destruction by other immune cells.

Your son's doctor was able to determine your son had been recently exposed to mono by looking for IgG specifically keyed to the Epstein Barr virus and finding high levels, indicating he had had a recent infection. Over time, the immunoglobulins diminish and some of the mature B-cells become memory B-cells that circulate for decades in the blood, looking specifically for Epstein Barr viruses. If the B-cell receptor 'locks' are again triggered by the Epstein Barr antigen key, once again a clonal response occurs, churning out more antibodies to flag Epstein Barr viruses for destruction before an infection has a chance to become re-established. This is why we are sick for several weeks the first time we are exposed to viruses (remember childhood experiences with measles, mumps and chicken pox?), but when we are exposed again later, we might feel a bit off colour for a day or so, if we even notice.

en.wikipedia.org/wiki/B-cel...

Lymph nodes are where this clonal B-cell growth happens, which is why our nodes swell when we have an infection. It's also why we have high concentrations of nodes around invasion points - our neck and throat (tonsils and adenoids are lymphoid tissue) and our groin and arm pits (to prevent infections from our limbs getting into our body). CLL cells are just B-cells that haven't properly developed and don't die off as fast as they should, so they accumulate.

We have several hundred lymph nodes throughout our body, but we are more aware of those that are near the skin's surface like your son's. Your son's doctor presumes that the node you are concerned about swelled due to the clonal growth of B-cells needed to fight the mono. It should go down as the B-cells in that node slip into the blood stream and/or die off. If it doesn't do so, (and I don't know how long to give it - I'm not a doctor), I'd recommend your son ask his doctor about doing a node biopsy to check that he doesn't have a lymphoma. 21 is extremely young to develop CLL, but to provide peace of mind, CLL/SLL or any other lymphoma needs to be ruled out.

Neil

[Psmithuk in reply to AussieNeil]

Brilliant reply, Neil. I hope it helps Jerseywish. Even I understood most of it!

[Jerseywish2011 in reply to AussieNeil]

Thank you Neil! Your replies are always so easy to understand and helpful. Thanks again!

[catmad1]

Hi there. I may be sticking my neck out here, and all those that are better informed are invited to shoot me down in flames, but.... Your son is young and I understand that there is a highly likely chance that he has been actually kissing (!) a fellow student, and that this is the way that the virus gets passed around. Ok you may now all shoot me down....Catmad 1

[MsLockYourPosts Passed Volunteer]

LOL! Catmad! Don't tell his parents! What happens in college stays in college!

[Alpha66]

Full blood count ,inc, lymphocytes.