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Peripheral lymphadenopathy (LAP) refers to abnormal enlargement of lymph nodes. LAP is commonly caused by infection and can be detected by palpation. Evaluation involves assessing location, size, consistency, and mobility of lymph nodes. Further diagnostic tools include ultrasound, biopsy, and histopathology. Biopsy is recommended for LAP persisting over 2 weeks, involving multiple lymph node groups, or lymph nodes over 1 cm. Histopathology reveals patterns that can indicate conditions like infections, autoimmune disorders, or Hodgkin's lymphoma.
Peripheral lymphadenopathy (LAP) refers to abnormal enlargement of lymph nodes. LAP is commonly caused by infection and can be detected by palpation. Evaluation involves assessing location, size, consistency, and mobility of lymph nodes. Further diagnostic tools include ultrasound, biopsy, and histopathology. Biopsy is recommended for LAP persisting over 2 weeks, involving multiple lymph node groups, or lymph nodes over 1 cm. Histopathology reveals patterns that can indicate conditions like infections, autoimmune disorders, or Hodgkin's lymphoma.
Peripheral lymphadenopathy (LAP) refers to abnormal enlargement of lymph nodes. LAP is commonly caused by infection and can be detected by palpation. Evaluation involves assessing location, size, consistency, and mobility of lymph nodes. Further diagnostic tools include ultrasound, biopsy, and histopathology. Biopsy is recommended for LAP persisting over 2 weeks, involving multiple lymph node groups, or lymph nodes over 1 cm. Histopathology reveals patterns that can indicate conditions like infections, autoimmune disorders, or Hodgkin's lymphoma.
PERIPHERAL LYMPHADENOPATHY (LAP) Lymphadenopathy : conditions in which lymph nodes become abnormal in size, consistency & number LAP located deep in the subcutaneous tissue, can be palpated if enlarge LAP : 75% localized, 50% in head & neck area Cervical lymph node infection >>>, supraclavicular malignancy FNA / excisional biopsy Gold standard for etiology of LAP Size (N) : < 1 cm (diameter) < 1.5 cm (inguinal lymph node) < 0.5 cm2 (epitrochlear nodes) < 2 cm (age 2 -10 yo) > 2 cm malignancy (lymphoma) or granulomatous disease (TB) PHYSICAL EXAMINATION Location : Localized vs generalized Local disease : LAP in lymphatic-rich region / red lymphangitic streaking Malignancy : several gruops of nodes, supraclavicular (90% > 40 yo; 25% < 40 yo) Virchow node in left supraclavicular area intraabdominal malignancy -Drain the gastrointestinal tract & genitourinary tract Right side intra-thoracic malignancy -Drain the mediastinum, lungs, esophagus Size Supraclavicular, iliac, popliteal, epitrochlear : > 0.5 cm Inguinal node : > 1.5 cm Other area : > 1 cm Consistency Acute inflammation : more consistent with concomitant pain tension on the caps Chronic inflammation : hard in palpation fibrotic changes Metastasis / Granulomatous : Stony-hard & painless Lymphoma : Firm & rubbery node Matted lymph node benign (M. TB & sarcoidosis) or malignant (lymphoma & metastatic) PHYSICAL EXAMINATION Mobility Freely mobile in subcutaneous : infection & cllagen vascular disease Rubbery mobile node : Lymphoma Fixed to the skin / surrounding tissue : Malignancy With organomegaly (ex splenomegaly) : mononucleosis, acte lymphoma, Hodgkins disease, non-Hodgkins lymphoma, sarcoidosis Check the skin for malignancy (melanoma) or traumatic region Pain & Tenderness Non-spesific Infection >>>> Hemorrhage into necrotic center of a neoplastic area Rapid tumor expansion or immunologic stimulation of pain receptor DIFFERENTIAL DIAGNOSIS MNEMONIC C : Cancers (HL & NHL, Leukemia, metastatic (breast, lung, kidney, others)) H : Hypersensitivity syndrome (Serum sickness, drugs) I : Infection : viral (EBV, cytomegalovirus, HIV), bacterial (TB), fungal, protozoa, rickettsial (typus), helminthes C : Connective tissue disorders : SLE, RA, deratomyositis A : Atypical lymphoproliferative disorders : Castlemans disease, Wegener G : Granulomatous : Histoplasmosis, Mycobacterium infection, Cryptococcus, Berrylliosis, Cat scratch disease, silicosis O : Others ULTRASOUND B-mode : Assesment of number, size, site, shape, margin, internal structure Color Doppler : vascular pattern, displacement of vascularity, vascular resistence, PI, distinguish old LAP and recent active LAP Criteria : Lymph node cortical thickness & uniformity N : Reniform shape, hypoechoic cortex with max. Thickness 3 mm, smooth margin, central fatty hilum TISSUE DIAGNOSIS Increased risk of malignancy Oliver S Soldes et al. > 8 yo, node size diameter > 1 cm, multiple adenopathy, supraclavicular lymph nodes, fixed nodes, abnormal CXR NHMRC Lymph node biopsy : age > 40 years, supraclavicular lymph node, nodal diameter > 2.25 cm, firm-hard texture, lack of pain HISTOPATHOLOGY 5 distinct pattern of benign LAP Follicular hyperplasia : increase in the size & number of B-cell in the germinal center Infection, autoimmune disorders, non-spesific reaction Paracortical hyperplasia : extension of the T-cells in the paracortical region Sinus hyperplasia : expansion of histiocyte cell in the medullary & cortical sinuses Inflammation & malignancy Granulomatous inflammation : formation of histiocytic granuloma TB, sarcoidosis Acute lymphadenitis : follicular hyperplasia & infiltration PMN cells Bacterial infection HODGKINS LYMPHOMA (WHO) Nodular sclerosis (80%) : young adult Lymphocyte-rich Mixed cellularity Lymphocyte-depleted Nodular lymphocyte-predominant
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