Lymphadenopathy

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Lymphadenopathy
Other namesAdenopathy, swollen lymph nodes, swollen glands
CT of axillary lymphadenopathy - annotated.jpg
A CT scan of axillary lymphadenopathy in a 57-year-old man with multiple myeloma.
Specialty Infectious disease, oncology
Symptoms Fever; Hard, fixed, rapidly growing nodes, indicating a possible cancer or lymphoma; night sweats; runny nose; sore throat
CausesInfections; autoimmune diseases; malignancies; histiocytoses; storage diseases; benign hyperplasia; drug reactions
Risk factors Back pain; constipation; urinary frequency
Diagnostic method CT scan; MRI scan; ultrasound

Lymphadenopathy or adenopathy is a disease of the lymph nodes, in which they are abnormal in size or consistency. Lymphadenopathy of an inflammatory type (the most common type) is lymphadenitis, [1] 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. [2] Infectious lymphadenitis affecting lymph nodes in the neck is often called scrofula.

Contents

Lymphadenopathy is a common and nonspecific sign. Common causes include infections (from minor causes such as the common cold and post-vaccination swelling to serious ones such as HIV/AIDS), autoimmune diseases, and cancer. Lymphadenopathy is frequently idiopathic and self-limiting.

Causes

Retroperitoneal lymphadenopathies of testicular seminoma embrace the aorta. Computed tomography image. Retroperitoneal lymphadenopathy of testicular seminoma, 1 50, CT image.svg
Retroperitoneal lymphadenopathies of testicular seminoma embrace the aorta. Computed tomography image.

Lymph node enlargement is recognized as a common sign of infectious, autoimmune, or malignant disease. Examples may include:

Infectious causes of lymphadenopathy may include bacterial infections such as cat scratch disease, tularemia, brucellosis, or prevotella, as well as fungal infections such as paracoccidioidomycosis. [14] [15]

Benign (reactive) lymphadenopathy

Benign lymphadenopathy is a common biopsy finding, and may often be confused with malignant lymphoma. It may be separated into major morphologic patterns, each with its own differential diagnosis with certain types of lymphoma. Most cases of reactive follicular hyperplasia are easy to diagnose, but some cases may be confused with follicular lymphoma. There are seven distinct patterns of benign lymphadenopathy: [6]

These morphological patterns are never pure. Thus, reactive follicular hyperplasia can have a component of paracortical hyperplasia. However, this distinction is important for the differential diagnosis of the cause.

Diagnosis

Medical ultrasonography of a typical normal lymph node: smooth, gently lobulated oval with a hypoechoic cortex measuring less than 3 mm in thickness with a central echogenic hilum. Ultrasonography of a normal lymph node.jpg
Medical ultrasonography of a typical normal lymph node: smooth, gently lobulated oval with a hypoechoic cortex measuring less than 3 mm in thickness with a central echogenic hilum.
Ultrasonography of a suspected malignant lymph node: - Absence of the fatty hilum - Increased focal cortical thickness greater than 3 cm - Doppler ultrasonography that shows hyperaemic blood flow in the hilum and central cortex and/or abnormal (non-hilar cortical) blood flow. Ultrasonography of a suspected malignant lymph node.jpg
Ultrasonography of a suspected malignant lymph node:
- Absence of the fatty hilum
- Increased focal cortical thickness greater than 3 cm
- Doppler ultrasonography that shows hyperaemic blood flow in the hilum and central cortex and/or abnormal (non-hilar cortical) blood flow.

In cervical lymphadenopathy (of the neck), it is routine to perform a throat examination including the use of a mirror and an endoscope. [27]

On ultrasound, B-mode imaging depicts lymph node morphology, whilst power Doppler can assess the vascular pattern. [28] B-mode imaging features that can distinguish metastasis and lymphoma include size, shape, calcification, loss of hilar architecture, as well as intranodal necrosis. [28] Soft tissue edema and nodal matting on B-mode imaging suggests tuberculous cervical lymphadenitis or previous radiation therapy. [28] Serial monitoring of nodal size and vascularity are useful in assessing treatment response. [28]

Fine-needle aspiration cytology (FNAC) has sensitivity and specificity percentages of 81% and 100%, respectively, in the histopathology of malignant cervical lymphadenopathy. [27] 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. [27]

Classification

Lymphadenopathy may be classified by:

Inflammatory localized lymphadenopathy at right mandibular angle sthaaniiy' limphayaaddinopyaathi.jpg
Inflammatory localized lymphadenopathy at right mandibular angle

Size

Long and short axis.png
Micrograph of dermatopathic lymphadenopathy, a type of lymphadenopathy. H&E stain. Dermatopathic lymphadenopathy - low mag.jpg
Micrograph of dermatopathic lymphadenopathy, a type of lymphadenopathy. H&E stain.
  • By size, where lymphadenopathy in adults is often defined as a short axis of one or more lymph nodes is greater than 10mm. [29] [30] However, there is regional variation as detailed in this table:
Upper limit of lymph node sizes in adults
Generally10 mm [29] [30]
Inguinal10 [31] – 20 mm [32]
Pelvis 10 mm for ovoid lymph nodes, 8 mm for rounded [31]
Neck
Generally (non-retropharyngeal)10 mm [31] [33]
Jugulodigastric lymph nodes 11mm [31] or 15 mm [33]
Retropharyngeal8 mm [33]
  • Lateral retropharyngeal: 5 mm [31]
Mediastinum
Mediastinum, generally10 mm [31]
Superior mediastinum and high paratracheal7mm [34]
Low paratracheal and subcarinal11 mm [34]
Upper abdominal
Retrocrural space6 mm [35]
Paracardiac8 mm [35]
Gastrohepatic ligament8 mm [35]
Upper paraaortic region9 mm [35]
Portacaval space10 mm [35]
Porta hepatis7 mm [35]
Lower paraaortic region11 mm [35]

Lymphadenopathy of the axillary lymph nodes can be defined as solid nodes measuring more than 15 mm without fatty hilum. [36] Axillary lymph nodes may be normal up to 30 mm if consisting largely of fat. [36]

In children, a short axis of 8 mm can be used. [37] However, inguinal lymph nodes of up to 15 mm and cervical lymph nodes of up to 20 mm are generally normal in children up to age 8–12. [38]

Lymphadenopathy of more than 1.5–2 cm increases the risk of cancer or granulomatous disease as the cause rather than only inflammation or infection. Still, an increasing size and persistence over time are more indicative of cancer. [39]

See also

Related Research Articles

<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> Abnormal change in size of the neck lymph nodes

The disease mycobacterial cervical lymphadenitis, also known as scrofula and historically as king's evil, involves a lymphadenitis of the cervical (neck) 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">Tuberculous lymphadenitis</span> Medical condition

Peripheral tuberculous lymphadenitis is a form of tuberculosis infection occurring outside of the lungs. In general, it describes tuberculosis infection of the lymph nodes, leading to lymphadenopathy. When cervical lymph nodes are affected, it is commonly referred to as "Scrofula." A majority of tuberculosis infections affect the lungs, and extra-pulmonary tuberculosis infections account for the remainder; these most commonly involve the lymphatic system. Although the cervical region is most commonly affected, tuberculous lymphadenitis can occur all around the body, including the axillary and inguinal regions.

Splenic marginal zone lymphoma (SMZL) is a type of marginal zone lymphoma, a cancer made up of B-cells that replace the normal architecture of the white pulp of the spleen. The neoplastic cells are both small lymphocytes and larger, transformed lymphoblasts, and they invade the mantle zone of splenic follicles and erode the marginal zone, ultimately invading the red pulp of the spleen. Frequently, the bone marrow and splenic hilar lymph nodes are involved along with the peripheral blood. The neoplastic cells circulating in the peripheral blood are termed villous lymphocytes due to their characteristic appearance.

Angioimmunoblastic T-cell lymphoma is a mature T-cell lymphoma of blood or lymph vessel immunoblasts characterized by a polymorphous lymph node infiltrate showing a marked increase in follicular dendritic cells (FDCs) and high endothelial venules (HEVs) and systemic involvement.

<span class="mw-page-title-main">Thyroid nodule</span> Lump of tissue or fluid in the thyroid gland

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.

Lymphoid hyperplasia is the rapid proliferation of normal lymphocytic cells that resemble lymph tissue which may occur with bacterial or viral infections. The growth is termed hyperplasia which may result in enlargement of various tissue including an organ, or cause a cutaneous lesion.

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

Cervical lymphadenopathy refers to lymphadenopathy of the cervical lymph nodes. The term lymphadenopathy strictly speaking refers to disease of the lymph nodes, 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.

<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.

<span class="mw-page-title-main">Progressive transformation of germinal centres</span> Medical condition

Progressive transformation of germinal centres (PTGCs) is a reactive lymph node process of undetermined cause.

<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.

<span class="mw-page-title-main">HHV-8-associated MCD</span> Disease subtype

Human herpesvirus 8 associated multicentric Castleman disease is a subtype of Castleman disease, a group of rare lymphoproliferative disorders characterized by lymph node enlargement, characteristic features on microscopic analysis of enlarged lymph node tissue, and a range of symptoms and clinical findings.

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

Unicentric Castleman disease is a subtype of Castleman disease, a group of lymphoproliferative disorders characterized by lymph node enlargement, characteristic features on microscopic analysis of enlarged lymph node tissue, and a range of symptoms and clinical findings.

<span class="mw-page-title-main">Idiopathic multicentric Castleman disease</span> Medical condition

Idiopathic multicentric Castleman disease (iMCD) is a subtype of Castleman disease (also known as giant lymph node hyperplasia, lymphoid hamartoma, or angiofollicular lymph node hyperplasia), a group of lymphoproliferative disorders characterized by lymph node enlargement, characteristic features on microscopic analysis of enlarged lymph node tissue, and a range of symptoms and clinical findings.

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.

Pediatric-type follicular lymphoma (PTFL) is a disease in which malignant B-cells accumulate in, overcrowd, and cause the expansion of the lymphoid follicles in, and thereby enlargement of the lymph nodes in the head and neck regions and, less commonly, groin and armpit regions. The disease accounts for 1.5% to 2% of all the lymphomas that occur in the pediatric age group.

<span class="mw-page-title-main">Indolent lymphoma</span> Medical condition

Indolent lymphoma, also known as low-grade lymphoma, is a group of slow-growing non-Hodgkin lymphomas (NHLs). Because they spread slowly, they tend to have fewer signs and symptoms when first diagnosed and may not require immediate treatment. Symptoms can include swollen but painless lymph nodes, unexplained fever, and unintended weight loss.

References

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  2. ↑ "lymphangitis" at Dorland's Medical Dictionary
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