- Lymphadenopathy can result form neoplastic or inflammatory processes
- In the western adult population 50% of cases are neoplastic and 50% are inflammatory
- In children only 20% of cases are due to neoplasia
Picture provided by Sami Eldirini, Sudan
Causes of lymphadenopathy
- Neoplastic
- Solid tumours - melanoma, breast, head and neck cancers
- Haematological - lymphoma, leukaemia, myeloproliferative diseases
- Inflammatory
- Infection –bacterial, viral, fungal, tuberculosis
- Autoimmune – rheumatoid arthritis, systemic lupus erythematosis, tuberculosis
- Miscellaneous – angiofollicular hyperplasia, dermatopathic lymphadenitis
Clinical Assessment
- Clinical assessment should include:
- Duration of symptoms
- Distribution of lymphadenopathy
- Presence of pain
- Associated symptoms – fever, malaise, weight loss
- Examination – firm or rubbery, discrete or matted
- Presence of hepatosplenomegaly
Investigation
- Fine needle aspiration cytology may be useful for solid tumours
- Excision or incision biopsy required if suspect haematological disorder
- Risks of node biopsy (e.g. damage to accessory nerve) should be appreciated
- Specimens should be sent ‘dry’ to laboratory
- Will allow samples for imprint cytology or microbiological culture
Picture provided by Neha Dohiya, KG Hospital, Coimbature, India
Sentinel node biopsy
- Lymph node surgery may be used as both a diagnostic and staging procedure
- Staging may be achieved by a full regional lymph node dissection
- Provides useful prognostic information but does not increase survival
- Also associated with significant complications (e.g. lymphoedema, sensory disturbances)
- Many patients have no evidence of metastatic spread
- Therefore, node dissection can be associated with unnecessary morbidity
- The sentinel lymph node is the first draining node from a tumour
- Can be identified by the use of dye or radioisotope injected next to a tumour
- Agents often used include:
- Patent blue dye
- Technetium nanocolloid
- Blue dye and isotope in combination
- At time of surgery blue node will be seen and ‘hot’ node identified using a gamma probe
- Has been shown in melanoma and breast surgery to be accurate predictor of nodal status
- Associated with few complications
- Sparse node-negative patients the need for a lymph node dissection
Picture provided by Fernando Gomez, Hospital Valparisu, Valparisu, Chile
Bibliography
Evans L S, Hancock B W. Non-Hodgkin's lymphoma. Lancet 2003; 362:
139-146.
Leong S P L. The role of sentinel lymph nodes in malignant melanoma. Surg Clin North Am 2000; 80:
1741-1758.
Monta E T, Chang T, Leong S P L. Principles and controversies in lymphoscintigraphy with an emphasis on
breast cancer. Surg Clin North Am 2000; 80: 1721-1746.
Roland N J, Fenton J, Bhalla R K. Management of a lump in the neck. Hosp Med
2001: 62: 205-209.
Schrenk P, Rieger R, Shamiyeh A, Wayand W. Morbidity following sentinel lymph node biopsy versus axillary
lymph node dissection for patients with breast cancer. Cancer 2000; 88: 608-614.
Umapathy N, De R, Donaldson I. Cervical lymphadenopathy in children. Hosp Med
2003; 64: 104-107
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