Lymphadenopathy

Question 1

What is lymphadenopathy

Answer 1

Enlargement of a lymph node

Question 2

Lymphadenopathy differentials

Answer 2

Malignancy
- Metastatic
- Lymphoma
- (Leukaemia)

Inflammation
- SLE, RA etc
- Sarcoidosis
- Graft versus host disease
- Drugs such as phenytoin, allopurinol or isoniazid

Infection
- Infectious mononucleosis
- HIV, including seroconversion illness
- Eczema with secondary infection
- Rubella
- Toxoplasmosis
- CMV
- Tuberculosis
- Roseola infantum

Question 3

Lymphadenopathy associated symptoms

Answer 3

General
- Night sweats
- Significant weight loss
- Fatigue

Specific
- Alcohol induced pain at lymph nodes (hodgkin’s)
- itch without a rash

Question 4

Where would you want to examine a patient presenting with lymphadenopathy

Answer 4

• neck
• axillary
• abdomen
• groin
• spleen & liver

Question 5

Does metastatic cancer cause general or regional lymphadenopathy

Answer 5

Regional

Question 6

Regional lympadenopathy vs systemic lymphadenopathy aetiology

Answer 6

Regional
- Metastatic cancer
- Bacterial infection
- ‘reactive’ node

Systemic
- Rare bacterial infection e.g. TB
- Viral infection
- Lymphoma

Question 7

For viral lymphadenopathy,
- is the lymph node tender?
- what is its consistency?
- is its surface smooth?
- is the surrounding skin inflamed?
- is it tethered?

Answer 7

• is the lymph node tender? Yes
• what is its consistency? Hard
• is its surface smooth? Yes
• is the surrounding skin inflamed? No
• is it tethered? No

Question 8

For bacterial lymphadenopathy:
- is the lymph node tender?
- what is its consistency?
- is its surface smooth?
- is the surrounding skin inflamed?
- is it tethered?

Answer 8

• is the lymph node tender? Yes
• what is its consistency? Hard
• is its surface smooth? Yes
• is the surrounding skin inflamed? Yes
• is it tethered? Yes/No

Question 9

For lymphoma:
- is the lymph node tender?
- what is its consistency?
- is its surface smooth?
- is the surrounding skin inflamed?
- is it tethered?

Answer 9

• is the lymph node tender? No
• what is its consistency? Rubbery/soft
• is its surface smooth? Smooth
• is the surrounding skin inflamed? No
• is it tethered? No

Question 10

For metastatic carcinoma:
- is the lymph node tender?
- what is its consistency?
- is its surface smooth?
- is the surrounding skin inflamed?
- is it tethered?

Answer 10

• is the lymph node tender? No
• what is its consistency? Hard
• is its surface smooth? No - Irregular
• is the surrounding skin inflamed? No
• is it tethered? Yes

Question 11

can you diagnose lymphoma or metastatic carcinoma using radiological methods alone e.g. CT

Answer 11

No - must do biopsy

Question 12

What type of biopsy is required/preferred for diagnosing lymphoma/malignancy of lymph node

Answer 12

Large sample or whole lymph node biopsy
Allows to assess architecture of the lesion
(Fine needle aspirate or core biopsy often insufficient)

Question 13

Immunohistochemistry vs immunophenotyping use

Answer 13

Immunohistochemistry - solid/ lymph node (lymphoma)
Immunophenotyping - blood/ bone marrow (leukaemia)

Question 14

What technqiues would be used to assess a lymph node biopsy (4)

Answer 14

Histology-microscopic appearance
Immunohistochemistry
Cytogenetics e.g. FISH
Molecular analysis (gene expression)

Question 15

Lymphoma classification

Answer 15

If lymphoma… Hodgkin vs Non Hodgkin
If non Hodgkin… T cell vs B cell lymphoma
If B cell lymphoma… Low grade vs high grade

Question 16

Name three specific types of B cell lymphomas

Answer 16

Burkitt’s lymphoma - High grade B cell NHL that is extremely aggressive/rapid

Mantle cell lymphoma - looks like low grade but is actually really aggressive

Marginal zone NHL - often occurs in other places in the body in addition to the lymph nodes