Download cervical lymphadenopathy

CERVICAL
LYMPHADENOPATHY
Dept of Oral Medicine & Radiology
Yenepoya Dental College
Mangalore
Lymphnodes are
encapsulated centres of
lymphocyte differetiation
and proliferation
 Small, oval or reniform bodies
 About 0.1 – 2.5 cm long
 Numerous in neck, mediastinum, post
abdominal wall & pelvis
 about - 400 - 450 LN
 Head and neck - 60 – 70 LN
FUNCTIONS
 Generate mature and prime B and T cells
 Add antibodies to circulation
 Filter particles, microbes from lymph
1.
Submental
2.
Submandibular
3.
Parotid
4.
Upper cervical
5.
Middle cervical
6.
Lower cervical
7.
Supraclavicular fossa
8.
Posterior triangle
(accessory chain)
Lymphadenitis - an inflammation
or infection of lymph node and
frequently occurs when an infection
is present in the tissues drained by
particular node pathway
CAUSES
I . INFECTION
BACTERIAL / VIRAL / PARASITIC
II. NEOPLASIA
PRIMARY
SECONDARY- Ca / Mal Malanoma
III. MISCELANIOUS
SARCOIDOSIS / DRUG REACTION/C T DISEASES
Infectious Causes
Non-infectious causes
1.
Adenovirus
1.
Hodgkin's disease
2.
CMV
2.
Lymphomas
3.
Enterovirus
3.
Leukemia
4.
EBV
4.
Metastatic disease
5.
Herpes simplex
5.
Histiocytosis
6.
Staphlococcus infection
6.
SLE
7.
Cat Scratch Diseas
7.
Kawasaki Disease
LYMPH NODES
a. SITE ,
b. SIZE ,
c. NUMBER ,
d. TENDERNESS
e.CONSISTANCY,
f.. FIXITY,
INVESTIGATION
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HISTORY
CLINICAL EXAMINATION
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TEMP/ DRAINAGE/ DENTAL & MUCOSAL /ENT
SPECIAL INVESTIGATION
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BLOOD PICTURE
CHEST X RAY
SEROLOGY
KVIEM TEST
MANTOUX TEST
FNAC / FNAB
BIOPSY
FNAC
Two distinct types of benign LN enlargement
 Non tender
 Tender / painful
NON TENDER LYMPHOID
HYPERPLASIA
 Persistent chronic lymphadenitis or
A permanenly enlarged LN after
acute or chronic lymphadenitis
 LN are solitary, discrete, asymtomatic and freely
movable
 Submandibular ,submental and subdigastric LN
D/D
Secondary carcinoma – hard & fixed
Management
Patient recalled after 2 week & evaluated
If doubtful – removal of node & examination
ACUTE LYMPHADENITIS:
 Most common pathologic cervical
enlargement
 Primary infection in oral cavity,
nasal cavity , tonsils or Pharynx
 Cause painful , swollen nodes in
submental, submandibular /
subdigastric
 Rapid regression of inflammation
- nodes Normal & non- palpable
SEVERAL NODES MAY BE INVOLVED
MOVABLE OR FIXED
D/D
LUDWIG’S ANGINA
INFECTED CYST
MANAGEMENT
 When primary infection eliminated
Lymphadenitis regress
 Adequate doses of antibiotics
METASTATIC CARCINOMA TO CERVICAL NODES
 LN are frequent sites
 Result of metastatic spread from
primary tumors of head & neck
 Squmous cell carcinoma is most
common tumor spreading to
cervical LN
 Adenocarcinoma of salivary glands,
Scc of skin & melonoma metastasize
Lymphatic trunks drain upper extremities & rest of body
below clavicles, so solitary metastatic nodes can be from
primary tumors of breast, lungs & stomach
FEATURES
 Usually painless
Detected on clinical examination
Feel stony hard & freely movable till they penetrate node
capsule & Invade surrounding tissues
Submandibular & subdigastric nodes most frequent sites
D/D
 Fibrosed nodes or nodes undergone non tender
lymphoid hyperplasia
 Lymphoma (rubbery)
MANAGEMENT
 Combination of resection, radiation & chemotherapy
 Prognosis is guarded
LYMPHOMA
A neoplastic proliferation
within the reticuloendothelial system that
occurs as primry tumor of lymph node
FEATURES
 Solitary / multiple
 Unilateral / bilateral
 Usually rubbery
 Advanced cases – patient is ill with fever,
TC & DLC may be markedly changed
 Other node groups axillae, groin &
mediastinum involved
D/D
 Multiple & disseminated nodal involvement
occur in certain viral diseases & in mononucleosis
 Nodes are tender & painful
MANAGEMENT
 Radiation & chemotoxic drugs
conclusion
PALPABLE NODE
CHARACTERISTICS
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ACUTE INFECTION—LARGE,SOFT AND
TENDER
CHRONIC INFECTION—LARGE,FIRM,LESS
TENDER,MOBILE
LYMPHOMA—RUBBERY HARD,PAINLESS
MULTIPLE
TUBERCULOSIS—MULTIPLE,MATTED
MALIGNANCY—STONY HARD AND FIXED