Lymphadenopathy

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Lymphadenopathy (LAD) refers to enlargement of nodes, with or without tenderness
  • Always note size, number, tenderness, consistency and mobility of LAD
  • Localized LAD
    • Often from a local source,
  • Generalized LAD usually refers to LAD in at least 2 different lymph node regions              
    • Infection, neoplasia, drugs
Generalised lymphadenopathy: A few causes
  • Viral
    • EBV, CMV, HIV
    • Measles, rubella
  • Brucellosis
  • Syphilis
  • Lymphogranuloma venereum
  • Lymphomas
  • Leukaemias
  • Carcinoma
  • Systemic lupus erythematosus
  • Serum sickness
  • Drug reactions
  • Rheumatoid arthritis
  • Localised lymphadenopathy
  • TB
    • Cervical
    • Hilar
    • Abdominal
  • Filariasis
  • Skin infections
  • Cat scratch disease
  • Carcinoma
    • Breast, colon, etc
  • Tonsillitis
Lymphadenitis
  • Lymphadenitis means inflammation of the lymph node.
  • Lymphadenitis may be specific, such as.
    • Tuberculosis or syphilis,
  • Or more commonly, nonspecific, in which case a causative agent cannot be identified.
Acute Non-specific Lymphadenitis
  • Acute lymphadenitis is usually clinically apparent.
  • Nodes enlarged due to cellular infiltration and edema
  • The usual cause of acute lymphadenitis is a microbiologic agent or its toxic products (especially staphylococcus or streptococcus).
  • Cervical, axillary, inguinal, mesenteric lymph nodes
  • Gross: swollen, gray-red and engorged
  • Histologically :
    • Prominence of lymphoid follicles with large germinal centers
    • Pyogenic- necrosis
  • Abundance of neutrophils and other inflammatory cells. Necrosis is common.
Chronic Non-specific Lymphadenitis
  • Chronic lymphadenitis is particularly common in the inguinal, axillary, and cervical regions because these lymph nodes drain large areas of the body.
  • Non tender as capsules are not under increased tension
  • Several different morphologic alterations.
    • Follicular hyperplasia- rheumatoid arthritis, HIV, toxoplasmosis.
    • Paracortical lymphoid hyperplasia- expansion of interfollicular areas- acute viral infection especially infectious mononucleosis, drugs.
    • Sinus Histiocytosis- distension of sinusoids by macrophages- lymph nodes draining cancer,
Tuberculous Lymphadenitis
  • Most frequent form of extrapulmonary tuberculosis
  • Most common site- cervical lymph nodes
  • HIV negative patients- tends to be unifocal
  • HIV positive-  multifocal
Morphology
  • Gross   
    • Matted
    • Caseation necrosis
  • Micro
    • Granuloma
    • Caseation necrosis
    • AFB

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