Approach to Investigation of Lymphadenopathy Flashcards
what can cause an enlarged lymph node (lymphadenopathy)
lymphoma
infection (viral/bacterial)
metastatic cancer (breast, ovary etc)
connective tissue disease (sarcoidosis, SLE etc)
swollen lymph node and night sweats indicate what causes?
lymphoma
infection
menopause
swollen lymph node and weight loss indicate what causes?
lymphoma
other malignancy
infection
what other symptoms might accompany swollen lymph node?
itch without rash
alcohol induced pain
fatigue
differentials for lymphadenopathy?
reactive bacterial infection viral infection metastatic malignancy lymphoma
approach to examining lymphadenopathy?
is it regional or generalised?
regional often from infection/abscess etc in specific site
features of lymphadenopathy from viral infection?
tender hard smooth skin not inflamed not tethered
features of lymph node in bacterial infection?
tender hard smooth skin inflamed can be tethered in some cases
features of lymph node in lymphoma
not tender rubbery/soft smooth skin not inflamed not tethered
features of lymph node in metastatic carcinoma?
not tender hard irregular skin not inflamed tethered
investigations if lymphoma or other malignancy is suspected in lymph node?
biopsy (core or FNA)
need a big sample to assess lesion architecture
does lymphoma show in CT?
no
what does lymph node biopsy allow?
exclusion of other causes (reactive etc)
classification of lymphoma which guides treatment etc
helps understanding of pathogenesis
how is lymph node pathology assessed on biopsy?
histology (microscopic appearance) immunohistochemistry of solid node immunophenotyping of blood/marrow genetics analysis molecular analysis
function of immunohistochemistry?
confirms lymphoma
subclassifys type of lymphoma
look at pattern of proteins on the surface of lymphoma cells and use antibodies against these
look at CD (cluster of designation) numbers
