Cervical lymphadenopathy

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Swollen lymph node in the neck due to tick attached behind ear Ixodholfem8.jpg
Swollen lymph node in the neck due to tick attached behind ear

Cervical lymphadenopathy refers to lymphadenopathy of the cervical lymph nodes (the glands in the neck). The term lymphadenopathy strictly speaking refers to disease of the lymph nodes, [1] though it is often used to describe the enlargement of the lymph nodes. Similarly, the term lymphadenitis refers to inflammation of a lymph node, but often it is used as a synonym of lymphadenopathy.

Contents

Cervical lymphadenopathy is a sign or a symptom, not a diagnosis. The causes are varied, and may be inflammatory, degenerative, or neoplastic. [2] In adults, healthy lymph nodes can be palpable (able to be felt), in the axilla, neck and groin. [3] In children up to the age of 12 cervical nodes up to 1 cm in size may be palpable and this may not signify any disease. [4] If nodes heal by resolution or scarring after being inflamed, they may remain palpable thereafter. [1] In children, most palpable cervical lymphadenopathy is reactive or infective. In individuals over the age of 50, metastatic enlargement from cancers (most commonly squamous cell carcinomas) of the aerodigestive tract should be considered. [1]

Classification

Cervical lymphadenopathy in an individual with infectious mononucleosis Lymphadanopathy.JPG
Cervical lymphadenopathy in an individual with infectious mononucleosis
Lymph nodes in the neck Gray604a.png
Lymph nodes in the neck

Cervical lymphadenopathy can be thought of as local where only the cervical lymph nodes are affected, or general where all the lymph nodes of the body are affected.

Causes

Infection

Malignancy

Lymph nodes may become enlarged in malignant disease. This cervical lymphadenopathy may be reactive or metastatic. [1] Alternatively, enlarged lymph nodes may represent a primary malignancy of the lymphatic system itself, such as lymphoma (both Hodgkin's and non-Hodgkin's), [6] lymphocytic leukemia, [1] Lymphadenopathy that lasts less than two weeks or more than one year with no progressive size increase has a very low likelihood of being neoplastic. [9]

Metastatic lymph nodes are enlarged because tumor cells have detached from the primary tumor and started growing in the lymph node ("seeded"). Since cancer generally occurs more frequently in older people, this kind of lymphadenopathy is more common in older persons. [7] Metastatic lymph nodes tend to feel hard and may be fixed to underlying tissues and may or may not be tender. [7] Usually the lymph nodes that directly drain the area of the cancer are affected by the spread (e.g. Sometimes metastatic cervical lymph node is detected before the main cancer). In such cases, this discovery leads to a search for the primary malignancy, firstly in the nearby area with endoscopy, "blind" biopsies, and tonsillectomy on the side of the lymphadenopathy. If no tumor is found, then the rest of the body is examined, looking for lung cancer or other possible sites. If still no primary tumor is detected, the term "occult primary" is used. [8]

In lymphoma, usually there are multiple enlarged nodes which feel rubbery to palpation. [8]

Other causes

Diagnosis

In possible malignancy, it is routine to perform a throat examination including mirror and/or endoscopy. [11]

On ultrasound, B-mode imaging depicts lymph node morphology, whilst power Doppler can assess the vascular pattern. [12] B-mode imaging features that can distinguish metastasis and lymphoma include size, shape, calcification, loss of hilar architecture, as well as intranodal necrosis. [12] Soft tissue edema and nodal matting on B-mode imaging suggests tuberculous cervical lymphadenitis or previous radiation therapy. [12] Serial monitoring of nodal size and vascularity are useful in assessing treatment response. [12]

Fine needle aspiration cytology (FNAC) has a sensitivity and specificity percentages of 81% and 100%, respectively, in the histopathology of malignant cervical lymphadenopathy. [11] PET-CT has proven to be helpful in identifying occult primary carcinomas of the head and neck, especially when applied as a guiding tool prior to panendoscopy, and may induce treatment related clinical decisions in up to 60% of cases. [11]

Related Research Articles

<span class="mw-page-title-main">Lymphoma</span> Hematologic cancer that affects lymphocytes

Lymphoma is a group of blood and lymph tumors that develop from lymphocytes. The name typically refers to just the cancerous versions rather than all such tumours. Signs and symptoms may include enlarged lymph nodes, fever, drenching sweats, unintended weight loss, itching, and constantly feeling tired. The enlarged lymph nodes are usually painless. The sweats are most common at night.

<span class="mw-page-title-main">Lymph node</span> Organ of the lymphatic system

A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that include B and T cells. Lymph nodes are important for the proper functioning of the immune system, acting as filters for foreign particles including cancer cells, but have no detoxification function.

<span class="mw-page-title-main">Kikuchi disease</span> Medical condition

Kikuchi disease was described in 1972 in Japan. It is also known as histiocytic necrotizing lymphadenitis, Kikuchi necrotizing lymphadenitis, phagocytic necrotizing lymphadenitis, subacute necrotizing lymphadenitis, and necrotizing lymphadenitis. Kikuchi disease occurs sporadically in people with no family history of the condition.

<span class="mw-page-title-main">Mycobacterial cervical lymphadenitis</span> Human medical condition

The disease mycobacterial cervical lymphadenitis, also known as scrofula and historically as king's evil, involves a lymphadenitis of the cervical lymph nodes associated with tuberculosis as well as nontuberculous (atypical) mycobacteria.

<span class="mw-page-title-main">Tumors of the hematopoietic and lymphoid tissues</span> Tumors that affect the blood, bone marrow, lymph, and lymphatic system

Tumors of the hematopoietic and lymphoid tissues or tumours of the haematopoietic and lymphoid tissues are tumors that affect the blood, bone marrow, lymph, and lymphatic system. Because these tissues are all intimately connected through both the circulatory system and the immune system, a disease affecting one will often affect the others as well, making aplasia, myeloproliferation and lymphoproliferation closely related and often overlapping problems. While uncommon in solid tumors, chromosomal translocations are a common cause of these diseases. This commonly leads to a different approach in diagnosis and treatment of hematological malignancies. Hematological malignancies are malignant neoplasms ("cancer"), and they are generally treated by specialists in hematology and/or oncology. In some centers "hematology/oncology" is a single subspecialty of internal medicine while in others they are considered separate divisions. Not all hematological disorders are malignant ("cancerous"); these other blood conditions may also be managed by a hematologist.

<span class="mw-page-title-main">Lymphadenopathy</span> Disease of lymph nodes

Lymphadenopathy or adenopathy is a disease of the lymph nodes, in which they are abnormal in size or consistency. Lymphadenopathy of an inflammatory type is lymphadenitis, producing swollen or enlarged lymph nodes. In clinical practice, the distinction between lymphadenopathy and lymphadenitis is rarely made and the words are usually treated as synonymous. Inflammation of the lymphatic vessels is known as lymphangitis. Infectious lymphadenitis affecting lymph nodes in the neck is often called scrofula.

Lymph node biopsy is a test in which a lymph node or a piece of a lymph node is removed for examination under a microscope.

An oral medicine or stomatology doctor/dentist has received additional specialized training and experience in the diagnosis and management of oral mucosal abnormalities including oral cancer, salivary gland disorders, temporomandibular disorders and facial pain, taste and smell disorders; and recognition of the oral manifestations of systemic and infectious diseases. It lies at the interface between medicine and dentistry. An oral medicine doctor is trained to diagnose and manage patients with disorders of the orofacial region, essentially as a "physician of the mouth".

<span class="mw-page-title-main">Anal sac adenocarcinoma</span> Malignant tumor found in dogs

An anal sac adenocarcinoma is an uncommon and aggressive malignant tumor found in dogs that arises from the apocrine glandular tissue of anal sac. The disease exists in cats as well, but is much less common in that species. They are the second most common cancerous cause of hypercalcaemia in dogs, following T-cell lymphoma.

Orofacial granulomatosis (OFG) is a condition characterized by persistent enlargement of the soft tissues of the mouth, lips and the area around the mouth on the face, causing in most cases extreme pain. The mechanism of the enlargement is granulomatous inflammation. The underlying cause of the condition is not completely understood, and there is disagreement as to how it relates to Crohn's disease and sarcoidosis.

<span class="mw-page-title-main">Thyroid nodule</span> Medical condition

Thyroid nodules are nodules which commonly arise within an otherwise normal thyroid gland. They may be hyperplastic or tumorous, but only a small percentage of thyroid tumors are malignant. Small, asymptomatic nodules are common, and often go unnoticed. Nodules that grow larger or produce symptoms may eventually need medical care. A goitre may have one nodule – uninodular, multiple nodules – multinodular, or be diffuse.

<span class="mw-page-title-main">Rosai–Dorfman disease</span> Medical condition

Rosai–Dorfman disease, also known as sinus histiocytosis with massive lymphadenopathy or sometimes as Destombes–Rosai–Dorfman disease, is a rare disorder of unknown cause that is characterized by abundant histiocytes in the lymph nodes or other locations throughout the body.

Cancer of unknown primary origin (CUP) is a cancer that is determined to be at the metastatic stage at the time of diagnosis, but a primary tumor cannot be identified. A diagnosis of CUP requires a clinical picture consistent with metastatic disease and one or more biopsy results inconsistent with a tumor cancer

Lymphatic disease is a class of disorders which directly affect the components of the lymphatic system.

<span class="mw-page-title-main">Axillary lymphadenopathy</span> Medical condition

Axillary lymphadenopathy is distinguished by an increase in volume or changes in the morphology of the axillary lymph nodes. It can be detected through palpation during a physical examination or through changes in imaging tests. On a mammogram (MMG), normal lymph nodes typically appear oval or reniform with a radiolucent center representing hilar fat. The cortex is usually hypoechoic or even imperceptible on ultrasound imaging, whereas the medulla is hyperechoic. When a lymph node is damaged, whether by benign or malignant disease, it changes shape and structure, resulting in different patterns in imaging tests.

Lymph node metastasis is the spread (metastasis) of cancer cells into a lymph node.

<span class="mw-page-title-main">Follicular hyperplasia</span> Medical condition of lymphatic cells

Follicular hyperplasia (FH) is a type of lymphoid hyperplasia and is classified as a lymphadenopathy, which means a disease of the lymph nodes. It is caused by a stimulation of the B cell compartment and by abnormal cell growth of secondary follicles. This typically occurs in the cortex without disrupting the lymph node capsule. The follicles are pathologically polymorphous, are often contrasting and varying in size and shape. Follicular hyperplasia is distinguished from follicular lymphoma in its polyclonality and lack of bcl-2 protein expression, whereas follicular lymphoma is monoclonal, and expresses bcl-2.

Carcinoma of the tonsil is a type of squamous cell carcinoma. The tonsil is the most common site of squamous cell carcinoma in the oropharynx. It comprises 23.1% of all malignancies of the oropharynx. The tumors frequently present at advanced stages, and around 70% of patients present with metastasis to the cervical lymph nodes. . The most reported complaints include sore throat, otalgia or dysphagia. Some patients may complain of feeling the presence of a lump in the throat. Approximately 20% patients present with a node in the neck as the only symptom.

In CT scan of the thyroid, focal and diffuse thyroid abnormalities are commonly encountered. These findings can often lead to a diagnostic dilemma, as the CT reflects nonspecific appearances. Ultrasound (US) examination has a superior spatial resolution and is considered the modality of choice for thyroid evaluation. Nevertheless, CT detects incidental thyroid nodules (ITNs) and plays an important role in the evaluation of thyroid cancer.

Epstein–Barr virus–associated lymphoproliferative diseases are a group of disorders in which one or more types of lymphoid cells, i.e. B cells, T cells, NK cells, and histiocytic-dendritic cells, are infected with the Epstein–Barr virus (EBV). This causes the infected cells to divide excessively, and is associated with the development of various non-cancerous, pre-cancerous, and cancerous lymphoproliferative disorders (LPDs). These LPDs include the well-known disorder occurring during the initial infection with the EBV, infectious mononucleosis, and the large number of subsequent disorders that may occur thereafter. The virus is usually involved in the development and/or progression of these LPDs although in some cases it may be an "innocent" bystander, i.e. present in, but not contributing to, the disease.

References

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  2. ↑ Terézhalmy GT, Huber MA, Jones AC (2009). Physical evaluation in dental practice. Ames, Iowa: Wiley-Blackwell. pp. 120–23, 160, 172. ISBN   978-0-8138-2131-3.
  3. ↑ Ferrer, Robert (1998-10-15). "Lymphadenopathy: Differential Diagnosis and Evaluation". American Family Physician. 58 (6): 1313–20. PMID   9803196.
  4. 1 2 Hupp JR, Ellis E, Tucker MR (2008). Contemporary oral and maxillofacial surgery (5th ed.). St. Louis, Mo.: Mosby Elsevier. pp. 428–30. ISBN   9780323049030.
  5. 1 2 3 4 5 Scully, Crispian (2008). Oral and maxillofacial medicine : the basis of diagnosis and treatment (2nd ed.). Edinburgh: Churchill Livingstone. pp. 14, 69–73, 101. ISBN   9780443068188.
  6. 1 2 Treister NS, Bruch JM (2010). Clinical oral medicine and pathology. New York: Humana Press. pp. 99, 149. ISBN   978-1-60327-519-4.
  7. 1 2 3 4 5 Kalantzis A, Scully C (2005). Oxford handbook of dental patient care, the essential guide to hospital dentistry (2nd ed.). New York: Oxford University Press. pp. 47, 343. ISBN   9780198566236.
  8. 1 2 3 Odell EW, ed. (2010). Clinical problem solving in dentistry (3rd ed.). Edinburgh: Churchill Livingstone. pp. 91–94. ISBN   9780443067846.
  9. ↑ Abba, Abdullah A.; Khalil, Mohamed Z. (2012-01-01). "Clinical approach to Lymphadenopathy". Annals of Nigerian Medicine. 6 (1): 11. doi: 10.4103/0331-3131.100201 . ISSN   0331-3131.
  10. ↑ Leão, JC; Hodgson, T; Scully, C; Porter, S (Nov 15, 2004). "Review article: orofacial granulomatosis". Alimentary Pharmacology & Therapeutics. 20 (10): 1019–27. doi: 10.1111/j.1365-2036.2004.02205.x . PMID   15569103. S2CID   33359041.
  11. 1 2 3 Balm, A. J. M.; van Velthuysen, M. L. F.; Hoebers, F. J. P.; Vogel, W. V.; van den Brekel, M. W. M. (2010). "Diagnosis and Treatment of a Neck Node Swelling Suspicious for a Malignancy: An Algorithmic Approach". International Journal of Surgical Oncology. 2010: 1–8. doi: 10.1155/2010/581540 . ISSN   2090-1402. PMC   3265261 . PMID   22312490.
  12. 1 2 3 4 Ahuja, A.T. (2008). "Ultrasound of malignant cervical lymph nodes". Cancer Imaging. 8 (1): 48–56. doi:10.1102/1470-7330.2008.0006. ISSN   1470-7330. PMC   2324368 . PMID   18390388.
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