Hematology - Lymph Disorders

Question 1

Differentiate between inflammatory and neoplastic lymph nodes

Answer 1

Consistency
- rubbery in inflammatory
- firm/hard in malignant
Mobility
- mobile in inflammatory
- matted/immobile in malignant
Tenderness
- tender in inflammatory
- non-tender in malignant
Size
- <2cm in inflammatory
- >2cm in malignant
Investigation
- malignant require excision biopsy, core biopsy or fine needle biopsy

Question 2

List the differential for generalized lymphadenopathy

Answer 2

Infection
- bacterial: TB, Lyme, cat-scratch disease
- viral: EBV, CMV, HIV
- parasitic: toxoplasmosis
- fungal: blastomycosis
Inflammatory
- rheumatologic: RA, SLE, vasculitis, Sjogren
- Drug hypersensitivity
- infiltrative: sarcoidosis, amyloidosis
- serum sickness
Neoplastic
- blood: lymphoproliferative disorder, lymphoma
- metastatic cancer
- histocytosis X

Question 3

Discuss the exam and investigations for splenomegaly

Answer 3

Exam
- jaundice, stigmata of chronic liver disease
- Petechiae for thrombocytopenia
- palpation and percussion of spleen (Castell's sign)
- palpation and percussion of liver
- CHF
Investigations
- CBC, blood film, reticulocyte count
- LDH, haptoglobin, LFT

Question 4

List the differential for splenomegaly

Answer 4

Hematological
- hemolysis
- nutritional anemia
- hemoglobinopathy
- spherocytosis, elliptocytosis
Infection
- CMV
- Bacterial endocarditis
- TB
- HIV/AIDS
- EBV
- Histoplasmosis
Inflammatory
- SLE
- Felty syndrome
- Still's disease
Vascular
- Splenic vein thrombosis
- Portal vein obstruction
- Portal vein hypertension
Infiltrative
- benign metaplasia
- amyloidosis, sarcoidosis
- lysosomal or glycogen storage diseasse
Malignancy
- Leukemia
- Lymphoproliferative disorder
- Hodgkin's lymphoma
- Myeloproliferative disease
- Metastatic