Lymphadenopathy

  • 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

Burkett's lymphoma

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

Caeseous necrosis of lymph node due to tuberculosis

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

Breast sentnel node biopsy

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

Veronesi U, Paganelli G, Galimberti V et al. Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph nodes. Lancet 1997; 349: 1864-67

 

 
 

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