October 5, 2015 - Clinical Cases in Lymphadenopathy Flashcards
Key Features to Assess on Lymph Node
Location: consider drainage area
Size: abnormal is generally >1 cm
Consistency: hard may be carcinoma, rubbery may be lymphoma, fluctuant may be infectious
Fixation: normal nodes are freely mobile
Tenderness: often inflammatory, but may be malignant
Localized vs Generalized/Diffuse
Localized is 1 or 2 lymph node groups enlarged
Diffuse is multiple
Hodgekin’s Lymphoma
Is a malignancy of the lymphoid tissue characterized by the presence of the malignant Reed-Sternberg cell. It always originates in a lymph node and spreads through adjacent lymphoid tissues.
Neoplastic cells only account for 1-2% of the cellular composition.
EBV is present in 50% of cases. This causes rapid division and increased chance for mutations to occur.
Reed-Sternberg Cell
A hallmark of Hodgkin’s Lymphoma.
Treatment for Neoplastic Lymphadenopathy
Surgery for diagnosis, but it is not enough for a cure.
Chemotherapy and radiation are used to eliminate all cells.
Polyclonal vs Monoclonal
Polyclonal is reactive
Monoclonal is malignant
Classical Hodgekin’s Lymphoma
Presentation in a bimodal age distribution.
Mostly presents as cervical lymphadenopathy.
Night sweats, weight loss, lack of appetite.
On exam, soft, rubbery, mobile, non-tender lymph nodes.
Spreads in an orderly fashion.
One of the few curable cancers.
Has the Reed-Sternberg cells.
Non-Hodgekin’s Lymphoma
Most common subtypes are diffuse large B-cell lymphoma, follicular lymphoma, and chronic lymphocytic leukemia (CLL).
Burkitt’s Lymphoma
Often in humid, malarial regions of Africa.
Presents as a huge swelling around the jaw.
Linked to EBV.
