8/ Lymphadenopathy

Question 1

What are the two types of lymphadenopathy?

Answer 1

• lymphadomegaly

- lymphadenitis

Question 2

What is the normal size of a lymph node?

Answer 2

10mm by 15mm

- the short axis is the most sensitive indicator of enlargement

Question 3

What is the clinical significant of a 1:1 short to long axis ratio of a lymph node?

Answer 3

rounder lymph node could indicate malignancy

Question 4

Define generalised lymphadenopathy

Answer 4

two or more non continuous nodal regions showing enlargement

Question 5

What are the causes of lymph node enlargement?

Answer 5

• in situ proliferation of leukocytes
• influx of leukocytes from other locations
• infiltration of neoplastic cells
• accumulation of foreign or endogenous substances

Question 6

If the origin of the enlargement is not known, when is the only time this should be treated?

Answer 6

if life threatening airway obstruction

Question 7

What is important in the history from patients with lymph node enlargement?

Answer 7

focus on family, occupation, co-morbiltides (particularly immunosuppression) and drugs

Question 8

What drugs can caused lymphadenopathy?

Answer 8

• anticonvulsants

Question 9

What can mediastinal node enlargement indicate?

Answer 9

• lymphoma
  TB
  sarcoidosis

Question 10

What can axillary lymph node enlargement be due to?

Answer 10

• skin infection
• breast cancer
• silicone leak from implants
• cat scratch disease

Question 11

What can inguinal node enlargement indicate?

Answer 11

cellulitis
lymphomas
melanomas

Question 12

When should malignancy be suspected?

Answer 12

fever 
night sweats 
unexplained weight loss 
generalised itching
immunosuppression 
rash

Question 13

Nodes in which locations are likely to be malignant?

Answer 13

• lower neck and abdomen more likely than upper regions
• supraclavicular, Virchow’s,
• isolated infraclavocilar node can indicate Hodgkins lymphoma

Question 14

What are the findings on palpation of a malignant node?

Answer 14

• fixed in place
• large
• hard
• painless

Question 15

What can commonly be mistaken for lymphadenophat?

Answer 15

granulomas

- topically defined collection of leukocytes rich in histocytes, this can be palpated and mistaken for lymphadenopathy

Question 16

Which non-neoplastic conditions are lymphoma like?

Answer 16

• 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

Question 17

What investigations should be done?

Answer 17

• a full blood count is usefully in excluding or diagnosing CLL
• Chest X-ray/CT
• biopsy from high risk nodes

Question 18

What type of biopsy should be done for lymphadenopathy?

Answer 18

Excision - should be performed where possible.
iF not then do incision
- core needle sometimes
DON’T use FNA

Question 19

Define lymphoma?

Answer 19

• 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

Question 20

Define leukaemia?

Answer 20

• 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