8/ Lymphadenopathy Flashcards
What are the two types of lymphadenopathy?
- lymphadomegaly
- lymphadenitis
What is the normal size of a lymph node?
10mm by 15mm
- the short axis is the most sensitive indicator of enlargement
What is the clinical significant of a 1:1 short to long axis ratio of a lymph node?
rounder lymph node could indicate malignancy
Define generalised lymphadenopathy
two or more non continuous nodal regions showing enlargement
What are the causes of lymph node enlargement?
- in situ proliferation of leukocytes
- influx of leukocytes from other locations
- infiltration of neoplastic cells
- accumulation of foreign or endogenous substances
If the origin of the enlargement is not known, when is the only time this should be treated?
if life threatening airway obstruction
What is important in the history from patients with lymph node enlargement?
focus on family, occupation, co-morbiltides (particularly immunosuppression) and drugs
What drugs can caused lymphadenopathy?
- anticonvulsants
What can mediastinal node enlargement indicate?
- lymphoma
TB
sarcoidosis
What can axillary lymph node enlargement be due to?
- skin infection
- breast cancer
- silicone leak from implants
- cat scratch disease
What can inguinal node enlargement indicate?
cellulitis
lymphomas
melanomas
When should malignancy be suspected?
fever night sweats unexplained weight loss generalised itching immunosuppression rash
Nodes in which locations are likely to be malignant?
- lower neck and abdomen more likely than upper regions
- supraclavicular, Virchow’s,
- isolated infraclavocilar node can indicate Hodgkins lymphoma
What are the findings on palpation of a malignant node?
- fixed in place
- large
- hard
- painless
What can commonly be mistaken for lymphadenophat?
granulomas
- topically defined collection of leukocytes rich in histocytes, this can be palpated and mistaken for lymphadenopathy
Which non-neoplastic conditions are lymphoma like?
- progressive transformation of germinal centres is a common autoimmune conditions that is PET-avid, however it is self-limiting and completely benign
- Kikuchi lymphadenitis is another autoimmune self-limiting condition that is common in Asian women. It can be differentiated from lymphoma due to a high CD8+ infiltration
What investigations should be done?
- a full blood count is usefully in excluding or diagnosing CLL
- Chest X-ray/CT
- biopsy from high risk nodes
What type of biopsy should be done for lymphadenopathy?
Excision - should be performed where possible.
iF not then do incision
- core needle sometimes
DON’T use FNA
Define lymphoma?
- neoplasm of lymphocytes, all of which are malignant
- can be highly aggressive or indolent
- can involve any organ, but most will originate in lymph nodes
- many are curable and nearly all are manageable with a long life expectancy
Define leukaemia?
- neoplasm with significant blood and bone marrow involvement, there is a considerable overlap between lymphoma and leukaemia as often lympphpmas will develop a leukaemic phase
- usually appleid to haematopoetic neoplasm
