lymphadenopathy

Question 1

what is it?

Answer 1

• Lymph node enlargement
• Localised, more wide-spread or generalised
• Peripheral or central (internal)

Question 2

what are the causes of stimulating different immune responses in a lymph node?

Answer 2

• Predominant B-cell response – auto-immune conditions, infections
• Predominant phagocytic response – non-specific, draining a tumour site
• Predominant T-cell response – viral infections, drugs e.g. phenytoin, dermatopathic

Question 3

what causes lymphadenopathy?

Answer 3

local inflammation - infection, vaccine, dermatopathic
systemic inflammation - infection, autoimmune, CT disorders
malignancy - haematological (lymphoma/leukaemia) or metastatic
drugs/toxin - drug induced hypersensitivity syndrome
metabolic

Question 4

how does it present?

Answer 4

A ‘lump’: lymphadenopathy
Itch without rash, alcohol-induced pain
Symptoms relevant to known/suspected systemic illness (INDAM)
B symptoms (general symptoms)
- fever 
- night sweats 
- weight loss (10% over 6 month period)

Question 5

how is it investigated?

Answer 5

• Full blood count – chronic lymphocytic leukaemia (CLL)-immunophenotyping
• Biochemical profile – compressive effects of lymphadenopathy, hypercalcaemia etc
• General investigations for systemic cause
• Biopsy – ‘the only way’ – for diagnosis and treatment
• Imaging – extent of lymphadenopathy and/or associated pathology

Question 6

what is key in examining regional lymphadenopathy?

Answer 6

examine the territory that drains to the group of nodes
Superficial lymphadenopathy may be the first sign of underlying malignancy
- localised lymphadenopathy can also be the 1st sign of lymphoma
- Anatomical knowledge can direct investigations to identify the primary lesion
- TNM cancer staging requires assessment of regional nodes – you need to know where to look

Question 7

what indicated superficial infection in regional lymphadenopathy?

Answer 7

red lines extending from an inflamed lesion – lymphangitis

Question 8

what does generalised lymphadenopathy suggest?

Answer 8

a systemic inflammatory/ immunological process or widespread malignancy

• If widespread malignancy lymphoma and leukaemia are high on the differential – check the FBC – a biopsy might not be necessary
• Clinical and pathology knowledge are most useful in directing investigations

Question 9

what is the characteristics of sarcoidosis as a cause of granulomatous lymphadenitis?

Answer 9

o A granulomatous condition
o Not purely a histological diagnosis
o Must exclude infection
o Sarcoid like reactions a pit fall – may mask malignancy in a lymph node

Question 10

what does granulomatous inflammation suggest?

Answer 10

o Many causes
o If caseous necrosis present – infectious cause (mycobacterial) until proven otherwise but other infections can cause similar appearances