Lymphadenopathy Flashcards
What is the function of the lymphatic system?
Lymphatics drain extracellular fluid from tissues.
The fluid is taken to the lymph nodes.
Thus, any infection will reach the lymph nodes
Causes
Infection (viral, bacterial)
Lymphoma
Metastatic cancer
CTD
Bacterial infection - generalised/regional lymphadenopathy?
Regional
Viral infection - generalised/regional lymphadenopathy?
Generalised
Give a common example of a viral cause of lymphadenopathy?
Glandular fever
When examining lymph nodes, which 5 things do you look for
Tenderness - yes or no Consistency - feeling: hard, soft, rubbery Surface - smooth or irregular Skin inflammation - yes or no Tethering - yes or no
Viral cause of lymphadenopathy: Tenderness Consistency Surface Skin inflammation Tethering
Tenderness - yes Consistency - hard Surface - smooth Skin inflammation - No Tethering - No
Bacterial cause of lymphadenopathy: Tenderness Consistency Surface Skin inflammation Tethering
Tenderness - yes Consistency - hard Surface - smooth Skin inflammation - Yes Tethering - maybe
Lymphoma cause of lymphadenopathy: Tenderness Consistency Surface Skin inflammation Tethering
Tenderness - No Consistency - Rubbery/soft Surface - Smooth Skin inflammation - No Tethering - No
Metastatic cancer cause of lymphadenopathy: Tenderness Consistency Surface Skin inflammation Tethering
Tenderness - no Consistency - hard Surface - irregular Skin inflammation - no Tethering - no
Patient with breast abscess, which lymph node region is most likely to have lymph nodes?
Axillary area
Patient with lower limb cellulitis, which lymph node region is most likely to have lymph nodes?
Inguinal area
If lymphoma or other malignancy is suspected, which investigation should be done?
Lymph node biopsy
- ask a surgeon to do this as FNA or core needle biopsy is often insufficient to make the diagnosis since you need a big sample to assess the architecture of the lesion
Why might lymph nodes be hard?
Due to cell infiltration.
Assessing lymph node pathology - histology
Microscopic appearance
Appreciation of architecture
Whole node sample is preferred to CT guided biopsy as this makes it easier
Assessing lymph node pathology - histology - what is seen in Hodgkin’s disease?
Nodular sclerosing
Assessing lymph node pathology - immunohistochemistry - what is this used to diagnose?
Lymphoma
- looks at a pattern of proteins on the surface of lymphoma cells
Assessing lymph node pathology - immunohistochemistry - what colour = positive
Brown
Assessing lymph node pathology - immunophenotyping
Use cells in liquid phase (blood/bone marrow rather than tissue)
Assessing lymph node pathology - immunophenotyping - which type of lymphoma in particular is this useful for?
Burkitts lymphoma
Assessing lymph node pathology - cytogenic analysis
Specific patterns of chromosome abnormality in certain lymphomas
FISH
When examining a patient with regional lymphadenopathy, where should you examine?
The territory that drains to that group of nodes
Bacterial cause of lymphadenopathy may show red skin inflammation. True or false?
True
Red lines extending from an inflamed lesion is called
Lymphangitis
Generalised lymphadenopathy - what is high on the list of Ddx
Lymphoma
Leukaemia
Stimulation of immune reaction in a lymph node - predominant B cell response
Auto immune conditions
Infections
Stimulation of immune reaction in a lymph node - predominant phagocytic response
Draining a tumour site
Stimulation of immune reaction in a lymph node - predominant T cell response
Viral infections
Drugs e.g. phenytoin
