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Cervical Lymphadenopathy Cervical lymphadenopathy Lymphatic cells are present in the whole body with cells of the hemopoetic sy In some tissues higher concentrationlymhonodes, tonsills, spleen, bone, marrow Basic function-mechanical filter -immunological barrier In ENT area-submental, submandibular, pre-and retroauricular, before and behind sternocledomast.muscle, occopital, nuchal, supra-and infraclavicular lnn. Basic investigation Case history Somatic investigation Ivestigation of the other organs according to location of lnn. Auxiliary laboratory tests Case history Age Job Sweating Fewer Loss of weigh Local or general infection Trauma Itching of the skin Pain of the joins Using of the drugs Contact with animals Time of enlargment Somatic investigation of lymph nodes Size Consistence(abscess, fluctuation, stiffnes, elasticity) Mobility or adherence Changes of the skin Sensitivity for palpation Division of the lymph nodes Consequence Liver and spleen Inflammation in the areas from tibutary tissues Marks of the symstemic disease(joins) Investigation of the nasopharynx, PNC,pharynx, larynx, tonsils, ear investigation Changes of the skin Laboratory tests Blood count Serology(IM,CMV,borrelia, syphillis, toxoplasmosis) Microbiology(culture from suspected areas,haemocolture, TB tests) X ray of lungs, mediastinum, ultrasound, CT Diagnostic removal of cerv. Lnn Histology Other auxiliary tests(revmatoid factor,HIV antib., LE cells, ANF..) CT Differential diagnosis Very wide Basic division: Acute Chronic 1.Inflammatory a.Non specific b.Specific 2.Neoplastic lymphadenopathy Non Specific Lymhadenopathy I Very often Acute painfull swelling Possible fluctuation Angina, CMV,Boreliosis,Rubeola virus,Adenovirus Revmatoid artritis Fatigue disease Dermatopoetic lymphadenopathy Lymphadenopathy due to drug hypersensitivity Child with lymphadenopathy Lymphadenopathy in acute tonsillitis Non Specific Lymphadenopathy II Benign angiofollicular lymhoma(Castleman) Collagenosis Monocutaneous lymphadenopathy(Kawasaki) Sjogren´s disease Non malignant idiopatic histiocytosis Disturbances of lipid metabolism(Niemann-Pick´s disease) 1b.Specific Lymphadenopathy TB Sarcoidosis(Bock´s disease) Lupus erytematodes Toxoplasmosis Cat scratch fever Tularemia Anthrax Syphyllis Lyme disease Brucelosis, Actinomycisis, Listeriosis, Leishmaniosis Cat scratch fever TB Tularemia HIV Lymphadenopathy 2.Neoplastic Lymhadenopathy A. Metastases B.Lymphomas Differential diagnosis Medial and lateral cysts, laryngocele, diseases of thyreoid gland, chemodectoma(carotic body tumor), neurogenic tumor, cervical lipoma, hemangioma, lymhangioma(cystic hygroma), cystadenolymhoma or other tu of salivary glands,malignant tumours of soft tissues Hodgkin's Lymphoma 2a.Lymph nodes metastases Carcinomatous cells reach the peripheral sinus of the lymph nodes via the afferent vessels Loss of mobility and adherence to sorrounding tissue due to malignant infiltration of the capsulae-worse prognosis Irregularly spreading of metastases due to obstructed lymph nodes TNM classification NO-regional lymph nodes are not palpable N1-mobile, homolateral enlarged lymph nodes N2-mobile, bilateral or contralateral lymph nodes N3-fixed lymph nodes Stage grouping based on TNM classification for malignant tumors Melanoma Neck cancer Malignant lymhoma Removal of lymph node