2 Lymphadenopathy Enlargement of the lymph nodes. Can be considered normal: 1) soft, flat, submandibular nodes (<1cm) in healthy children and young adults; 2) palpabale inguinal lymph nodes of up to 2cm in diameter in healthy adults.May be a primary or secondary manifestation of numerous disorders, both benign and malignant.
3 Clinical Assessment Medical History Physical Examination Laboratory TestsExcisional LN Biopsy
4 Medical HistoryReveals the setting in which lymphadenopathy is occuring.General information, accompanying symptoms, personal and social history.Ex.: viral/bacterial URTI, toxoplasmosis, TB benign disorders in children and young adults; if>50 y/o increase incidence of malignant disorder.
5 Physical ExaminationExtent of lymphadenopathy ( localized or generalized), size, texture, presence/ absence of tenderness, signs of inflammation over the node, skin lesions, and splenomegaly.ENT exam indicated in an adult patient with cervical lymphanedopathy with history of tobacco use.
6 Extent of Lymphadenopathy Localized/regional- involvement of a single anatomic site.Generalized- involvement of 3 or more non-contiguous lymph node areas; usually indicates non- malignant disorder (except for ALL, CLL, and malignant lymphomas.)
7 Site of Localized Adenopathy OccipitalPreauricularNeckSupraclavicular and scaleneVirchow’s nodesAxillaryInguinal
8 Size of the Node <1.0 cm2 –benign; non-specific causes. >2.0 cm/ >2.25cm2 -malignant or granulomatous disease.
9 Texture and Presence of Pain Acute leukemia- pain in nodes due to rapid enlargement.Lymphoma- large, discrete, symmetric, rubbery, firm, and non-tender.Metastatic cancer- hard, non-tender, and non moveable.W/ splenomegaly- systemic illness (IM, lymphoma, acute or chronic leukemia, etc.)
10 Thoracic AdenopathyDetected by CXR or work-up for superficial adenopathy.May cause coughing/wheezing, hoarseness, dysphagia, and/or swelling of the face and neck.Due to a primary lung disorder or systemic illness.
11 Abdominal and Retroperitoneal Adenopathy Usually malignant.TB mesenteric lymphadenitis; lymphoma; GCT in young men.
12 Laboratory Investigation CBCSerologyCXRCT and MRIUltrasound
13 Lymph Node Biopsy Done if PE findings suggest malignancy. Biopsy evident primary lesion first.FNAB- not to be used as primary diagnostic procedure; for thyroid nodules or confirmation of relapse in patient whose primary diagnosis is known.Guidelines: Older patients (>40y/o), large LN (>2.25cm2 ), hard and non-tender
14 Follow-up and Treatment Follow-up at 2-4 weeks interval for benign causes.Antibiotics are given only if there is strong evidence of bacterial infection.DO NOT USE GLUCOCORTICOIDS-might obscure diagnosis or delay healing in cases of infection (EXCEPTION: life-threatening pharyngeal obstruction by enlarged lymph tissue in Waldeyer’s ring caused by IM.)