Lymphadenopathy Clinical significance.pptx

Lymphadenopathy Clinical significance Etiopathogenesis Troisier Virchow 's node
Epitrochlear node Reticuloendothelial system

1. LYMPHADENOPATHY Dr. H. Budhichandra Singh Vertical integration with Pathology

2. Lymph nodes a part of the Re ticuloendothelial system Reticuloendothelial system comprises M onocytes of the blood M acrophages of the connective tissue T hymus S pleen Bo ne marrow M ucosa -associated lymphoid tissue of visceral organ s Lymph nodes L ymphatic vessels and lymphatic fluid found in interstitial fluid Lymph node functions as an antigen filter Exposes B-cell lymphocytes, T-cell lymphocytes, and macrophages to recognize and react to foreign antigens to mount an immune response  INTRODUCTION

3. INTRODUCTION Diseases of lymph nodes are almost always recognized by enlargement The enlargement may be solitary, regional, or generalized Solitary lymphadenopathy is enlargement of a single lymph node Regional lymphadenopathy is enlargement of lymph nodes draining an anatomic region Generalized lymphadenopathy is abnormal enlargement of more than two noncontiguous lymph node regions The enlargement is due to infiltration of cells into the node; the cell types may be normal lymph node constituents, inflammatory cells, or neoplastic infiltrates

4. ETIOLOGY The etiology of lymphadenopathy includes the following Infectious disease Neoplasm Inflammatory disease Autoimmune disease Inborn metabolic storage disorder Exposure to toxic/medication

5. Infectious disease Viral, bacterial, mycobacterial, fungal, or parasitic etiology Neoplastic causes Primary malignancies e.g. lymphoma Secondaries / metastasis Autoimmune disease these causes of lymphadenopathy Sarcoidosis, juvenile rheumatoid arthritis (JRA), serum sickness, systemic lupus erythematosus (SLE) Exposures to toxins and medications Common causes of lymphadenopathy include the medications allopurinol, atenolol, captopril, carbamazepine, many of the cephalosporins, gold, hydralazine, penicillin, phenytoin, primidone, para methylamine, quinidine, the sulfonamides etc Inborn metabolic storage disorders (including Niemann-Pick disease and Gaucher disease)  ETIOLOGY

6. The most powerful tool for diagnosis of lymphadenopathy is history and a thorough clinical examination Regional lymph node groups : Cervical, Axillary Inguinal groups Lymph nodes must be examined bilaterally Local lymphadenopathy suggests a more localized disease as compared t o generalized lymphadenopathy In general, c ervical lymph nodes and axillary nodes are atypical if > 1 cm, as compared to supraclavicular > 0.5 cm, and inguinal nodes >1.5 cm Ep itrochlear node > 0.5 cm is always pathological in an adult NODE MORPHOLOGY AND CHARACTERISTICS

7. H oweve r e xception to this rul e C hildren younger than ten have more hypertrophic immune systems, and nodes up to 2 cm can be considered normal in some clinical situations Ly mphadenopathy is more prevalent in children due to more v iral infections Supraclavicular adenopathy is almost always abnormal When it is not part of generalized lymphadenopathy, it is suggestive of a primary malignancy in either the abdomen or the chest Right-sided supraclavicular nodes drain parts of the lung and mediastinum so indicative of lung or esophageal malignancy NODE MORPHOLOGY AND CHARACTERISTICS

8. Left-sided supraclavicular nodes "Virchow's nodes," Close to the thoracic duct Troisier sign Signal intra-abdominal malignancies of stomach, ovaries, testes, or kidneys  T enderness or pain may result from an inflammatory process or result from hemorrhage into the necrotic center of a malignant node Consisten cy So fter nodes are usually the result of infection or inflammatory conditions F irm rubbery nodes may suggest lymphoma H ard stone like nodes are typically a sign of cancer more commonly metastatic than primary NODE MORPHOLOGY AND CHARACTERISTICS

9. "Shotty" nodes  Small, scattered nodes that feel like shotgun pellets under the ski n T ypically   f ound in cervical nodes of children with viral illnesses The designation of a "matting" configuration of Clustered, conjoined lymph nodes I ndicative of mycobacterial infection or malignanc y NODE MORPHOLOGY AND CHARACTERISTICS

10. Laboratory evaluation: Bl ood chemistries including complete blood count with differential, complete metabolic panel F ungal serologies (histoplasmosis, blast o mycosis, coccidioidomycosis, cryptococcosis) L aboratory evaluation of Syphilis, HIV, CMV, EBV, HSV, HBV, Tuberculosis Imaging : Computed Tomography (CT) of the chest, abdomen, and pelvis can be used to further substantiate the location of lymphadenopathy, pattern, and size Image guided biopsy E VALUATION

11. Cytology: Fine needle aspiration cytology (FNAC) Lymph node biopsy: Ex cisional lymph n ode biopsy is the gold standard for diagnosis of lymphadenopathy E VALUATION

12. De pendent on its etiolog y : Lymphadenopathy caused by a primary neoplasm: Treatment of the neoplasm Lymphadenopathy caused by metastasis-diagnosis of the primary: Treatment of the metastasis and primary neoplasm Lymphadenopathy caused by bacterial disease: Supportive care, antibiotics, and elimination of nidus of infection if applicable Lymphadenopathy caused by viral disease: Observation and supportive care or treatment of the virus if particular antiviral medications exist Lymphadenopathy caused by a toxin or medication exposure: Removal of offending medication if possible or avoidance of toxin TREATMENT

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