Masses, Lymphadenopathy and Splenomegaly

Question 1

Which infections cause localized anterior cervical LAD? (3)

Which malignancies cause localized anterior cervical LAD? (3)

Answer 1

Infection: EBV, CMV, toxoplasmosis.

Malignancy: lymphoma, CLL, head/neck cancer.

Question 2

Which infections cause localized posterior cervical LAD? (2)

Which malignancies cause localized posterior cervical LAD? (3)

Answer 2

Infection: EBV and Tb.

Malignancy: lymphoma, CLL, head/neck cancer.

Question 3

Which area of LAD is a high risk for malignancy?

Answer 3

Supraclavicular: 35-50% incidence, increased risk in those > 40 y/o.

Question 4

What does right-sided supraclavicular LAD suggest?

What does left-sided supraclavicular LAD (Virchow’s node) suggest? (1)

Answer 4

Right-sided: cancer in the mediastinum, lungs, esophagus.

Left-sided: abdominal malignancy.

Question 5

What infectious (1), malignant (2) and inflammatory (1) conditions can cause axillary LAD?

Answer 5

Infection: cat scratch disease.

Malignancy: skin or breast cancer.

Inflammatory: silicone breast implants.

Question 6

What infectious (5), malignant (1) and inflammatory (1) conditions can cause epitrochlear LAD?

Answer 6

Infection: forearm/hand infection, tularemia, strep infections, cat scratch disease, secondary syphilis.

Malignancy: lymphoma.

Inflammatory: sarcoidosis.

Question 7

What infectious (2) and malignant conditions (4) can cause inguinal LAD?

Answer 7

Infection: LE infection, STDs.

Malignant: lymphoma, skin cancer, GU cancers, anal/rectal cancer.

Question 8

What is the Sister Mary Joseph nodule?

What kind of malignancies is it associated with?

What does it suggest in terms of prognosis?

Answer 8

It is a palpable nodule in the umbilicus (not technically a LN, though).

Metastasis from intra-abdominal or intra-pelvic malignancy. Most commonly it is a GI cancer, but 25% can be associated with gynecological cancers.

It is a poor prognostic sign!

Question 9

What tends to cause generalized LAD? (4)

Answer 9

HIV

Mycobacterial infections

Viral infections (infectious mononucleosis)

Inflammatory conditions - SLE, etc.

Question 10

What size of LNs is considered “abnormal”?

What does “shotty” mean?

Answer 10

> 1 cm. in diameter.

“Shotty” is used to describe multiple, small node, but ir has not particular diagnostic significance.

Question 11

What does a hard vs. firm and rubbery vs. soft consistency of a LN suggest?

Answer 11

Hard nodes are found in cancers that induce fibrosis and when previous inflammation has left fibrosis.

Firm and rubbery nodes are found in lymphomas and chronic leukemias.

Softer nodes suggest acute leukemia.

Question 12

What are “B symptoms”?

What do they suggest?

Answer 12

Fever, night sweats, > 10% weight loss in previous 6 mo.

It is likely a paraneoplastic process and associated with a worse prognosis.

Question 13

Which patients are at an increased risk for a primary CNS lymphoma?

Answer 13

Immunosuppressed patients: HIV, transplant patients, etc.

Question 14

What testing wold you consider in a patient with generalized LAD initially?

How does that change is they come back normal?

Answer 14

CBC and CXR. If they are normal, consider:

• PPD
• HIV
• RPR
• ANA
• viral serologies

Question 15

What symptoms accompany splenomegaly?

Answer 15

Heaviness or pain in LUQ
Early satiety
Fullness or mass in LUQ

Question 16

What is myelofibrosis?

Before it is diagnosed, what should be ruled-out?

What is the triad of symptoms?

Answer 16

A primary MPD characterized by marrow fibrosis and EMH.

It should be differentiated from secondary myelofibrosis due to other MPDs or malignancy.

Leukoerythroblastic anemia
Poikilocytosis
Splenomegaly