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| | [[File:ImageLymphadenopathy.jpg|300px|thumb|right|Lymphadenopathy]] |
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| __NOTOC__ | | __NOTOC__ |
| {{Lymphadenopathy}} | | {{Lymphadenopathy}} |
| {{CMG}};{{AE}} {{ADS}}{{MV}} {{RT}} | | {{CMG}},{{shyam}};{{AE}} {{ADS}}, {{RT}} [[Ogechukwu Hannah Nnabude, MD]] |
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| {{SK}} Lymph nodes enlarged; Enlarged lymph nodes; Lymphadenitis; Swollen lymph nodes; Swollen/enlarged lymph nodes
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| | {{SK}} Lymph nodes enlarged; Enlarged lymph nodes; Lymphadenitis; Swollen lymph nodes; Swollen/enlarged lymph nodes<br> |
| | '''For patient information, click [[Xyz (patient information)|here]]''' |
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| ==Overview== | | ==Overview== |
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| | ==[[Lymphadenopathy classification|Classification]]== |
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| ==Classification== | | ==[[Lymphadenopathy pathophysiology|Pathophysiology]]== |
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| ==Pathophysiology==
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| *The pathogenesis of lymphadenopathy is characterized by the inflammation of lymph nodes. This process is primarily due to an elevated rate of trafficking of lymphocytes into the node from the blood, exceeding the rate of outflow from the node.<ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |year=2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref>
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| *The inmune response between the antigen and lymphocyte that leads to cellular proliferation and enlargement of the lymph nodes.
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| *Lymph nodes may also be enlarged secondarily as a result of the activation and proliferation of antigen-specific T and B cells (clonal expansion).
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| *On gross pathology, characteristic findings of lymphadenopathy, include:
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| :*Enlarged lymph node
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| :*Soft greasy yellow areas within capsule
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| *On microscopic histopathological analysis, characteristic findings of lymphadenopathy will depend on the aetiology.
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| *Common findings, include:<ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |year=2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref><ref name="AA">Lymph node enlargment. Wikipedia. https://en.wikipedia.org/wiki/Lymph_node Accessed on May 9, 2016</ref>
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| '''Non-specific reactive follicular [[hyperplasia]] (NSRFH)'''
| | ==Histopathology== |
| :*Large spaced cortical follicles
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| :*Tingible body [[macrophages]], normal dark/light GC pattern
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| '''Lymph node metastasis'''
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| :*Foreign cell population (usually in subcapsular sinuses)
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| :*+/-nuclear [[atypia]]
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| :* +/-malignant architecture
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| '''Toxoplasmosis'''
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| :*Large [[follicles]]
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| :*Epithelioid cells perifollicular & intrafollicular
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| :*Reactive GCs
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| :*Monocytoid cell clusters
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| '''Cat-scratch disease'''
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| :*PMNs in necrotic area
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| :*"Stellate" (or serpentine) shaped micro-abscesses
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| :*Presence of granulomas
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| '''Dermatopathic lymphadenopathy'''
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| :*Melanin-laden histiocytes
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| :*Histiocytosis
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| '''Systemic lupus erythematosus lymphadenopathy'''
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| :*Blue hematoxylin bodies
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| :*[[Necrosis]]
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| :*No PMNs
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| ==Causes== | | ==Causes== |
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| ==Differentiating Lymphadenopathy from other Diseases== | | ==[[Lymphadenopathy differential diagnosis|Differentiating Lymphadenopathy from other Diseases]]== |
| * Lymphadenopathy must be differentiated from [[syphilis]], which may present as [[fever]], [[myalgias]], [[weight loss]], and [[lymph node]] enlargement.<ref name="pmid1590633">{{cite journal |vauthors=Deschenes J, Seamone CD, Baines MG |title=Acquired ocular syphilis: diagnosis and treatment |journal=Ann Ophthalmol |volume=24 |issue=4 |pages=134–8 |year=1992 |pmid=1590633 |doi= |url=}}</ref>
| | ==[[Epidemiology and Demographics]]== |
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| ==Epidemiology and Demographics== | |
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| ==Risk Factors==
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| *The most common risk factors in the development of lymphadenopathy, include:
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| :*Local soft-tissue infections
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| :*[[Upper respiratory tract infection]]
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| :*Foreign travel
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| == Natural History, Complications and Prognosis==
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| == Diagnosis ==
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| ===Diagnostic Criteria===
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| ====Malignant Lymphadenopathy====
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| :*Node > 2 cm
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| :*Node that is draining, hard, or fixed to underlying tissue
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| :*Atypical location (e.g. [[supraclavicular]] node)
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| :*Risk factors (e.g. [[HIV AIDS|HIV]] or [[TB]])
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| :*[[Fever]] and/or weight loss
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| :*[[Splenomegaly]]
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| ====Benign Lymphadenopathy====
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| :*Node < 1 cm
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| :*Node that is mobile, soft-or tender, and is not fixed to underlying tissue
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| :*Common location (e.g. supraclavicular node)
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| :*No associated risk factors
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| :*Palpable and painful enlargement
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| ==History and Symptoms==
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| ===Head===
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| ====Palpating Anterior Cervical Lymph Nodes====
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| Lymph nodes should be examined in the following order:<ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |year=2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref><ref name="AA">Lymph node enlargment. Wikipedia. https://en.wikipedia.org/wiki/Lymph_node Accessed on May 9, 2016</ref>
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| *[[Anterior]] [[Cervical]]
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| *[[Posterior]] [[Cervical]]
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| *Tonsillar
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| * Sub-Mandibular
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| *Sub-Mental
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| *Supra-clavicular
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| '''Characteristics''' to be noted while palpating lymph nodes:<ref name="AA">Lymph node enlargment. Wikipedia. https://en.wikipedia.org/wiki/Lymph_node Accessed on May 9, 2016</ref>
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| *Size
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| *Pain/ tenderness
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| :*Increased tenderness (e.g infected lymph nodes)
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| *Consistency
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| *Matting
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| ====Gallery====
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:head_scc1.jpg|'''Cervical adenopathy''': massive right side cervical adenopathy and facial asymmetry due to metastatic, intraoral squamous cell cancer. Images Courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA.
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| Image:head_scc2.jpg|'''Cervical adenopathy''': massive right side cervical adenopathy and facial asymmetry due to metastatic, intraoral squamous cell cancer. Images Courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA.
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| Image:head_cervical_ln.jpg|'''Cervical adenopathy''': large right anterior cervical lymph node. Images Courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA.
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| Image: Lymphadenopathy 001.jpg| '''Cervical lymphadenopathy'''. Images Courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA.
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| Image:head_cneck_adenop1.jpg|'''Cervical Adenopathy''': multiple right sided cervical lymph nodes. Images Courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA.
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| </gallery>
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| </div>
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| === Laboratory Findings ===
| | ==Laboratory Evaluation of Lymphadenopathy== |
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| ===Imaging Findings=== | | ==Diagnostic Radiological Testing== |
| '''Ultrasonography'''
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| *On ultrasound, characteristic findings of lymphadenopathy, include:<ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |year=2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref><ref name="radio">Lymph node enlargment. Radiopedia. http://radiopaedia.org/articles/lymph-node-enlargement Accessed on May 9, 2016 </ref><ref name="AA">Lymph node enlargment. Wikipedia. https://en.wikipedia.org/wiki/Lymph_node Accessed on May 9, 2016</ref>
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| :*Increased lymph node size
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| '''CT'''
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| *On CT, characteristic findings of lymphadenopathy, include:<ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |year=2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref><ref name="radio">Lymph node enlargment. Radiopedia. http://radiopaedia.org/articles/lymph-node-enlargement Accessed on May 9, 2016 </ref><ref name="AA">Lymph node enlargment. Wikipedia. https://en.wikipedia.org/wiki/Lymph_node Accessed on May 9, 2016</ref><ref name="pmid10670052">{{cite journal |vauthors=van den Brekel MW, Castelijns JA |title=Imaging of lymph nodes in the neck |journal=Semin Roentgenol |volume=35 |issue=1 |pages=42–53 |date=January 2000 |pmid=10670052 |doi= |url=}}</ref><ref name="pmid11264102">{{cite journal |vauthors=Sumi M, Ohki M, Nakamura T |title=Comparison of sonography and CT for differentiating benign from malignant cervical lymph nodes in patients with squamous cell carcinoma of the head and neck |journal=AJR Am J Roentgenol |volume=176 |issue=4 |pages=1019–24 |date=April 2001 |pmid=11264102 |doi=10.2214/ajr.176.4.1761019 |url=}}</ref>
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| :*Most nodes: 10 mm in short-axis
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| :*Sub-mental and sub-mandibular: 15 mm
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| :*Retropharyngeal: 8 mm
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| :*Loss of fatty hilum
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| :*Focal [[necrosis]]
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| :*Cystic necrotic nodes
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| :*Long-to-short axis ratio (>2cm - usually [[benign]])
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| *The upper limit in size of a normal node varies with location.
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| '''PET/CT'''
| | ==Treatment== |
| *On PET/CT, lymphadenopathy can be further assessed via quantitation of FDG uptake, which is a surrogate of metabolic activity. Infectious, inflammatory, and neoplastic processes will show high FDG avidity on PET/CT. PET/CT is particularly useful for assessing response of lymph nodes to systemic chemotherapy.
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| '''MRI'''
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| *MRI is the most anatomically precise test for assessing lymphadenopathy. MRI is particularly useful for intraabdominal lymphadenopathy, which cannot be readily palpated via physical examination. MRI is more expensive than CT scan, so CT is preferred in general unless the clinical need for MRI arises.
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| == Treatment ==
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| *There is no treatment for lymphadenopathy; the mainstay of therapy is treating the underlying condition.<ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |year=2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref>
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| **Infectious lymphadenopathy responds well to prompt treatment with antibiotics, and usually leads to a complete recovery. However, it may take months, for swelling to disappear. The amount of time to recovery depends on the cause.<ref name="AA">Lymph node enlargment. Wikipedia. https://en.wikipedia.org/wiki/Lymph_node Accessed on May 9, 2016</ref>
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| **Neoplastic (malignant) lymphadenopathy usually responds well to systemic chemotherapy.
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| ==References== | | ==References== |
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| [[Category:Dermatology]] | | [[Category:Dermatology]] |
| [[Category:Medical signs]] | | [[Category:Medical signs]] |
| [[Category:Signs and symptoms]] | | [[Category: Signs and symptoms]] |
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| [[Category:Physical examination]] | | [[Category: Physical examination]] |
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