Download involvement of 3 or more noncontiguous lymph node areas.

LIMFADENOPATI
IRZA WAHID
SUBAGIAN HEMATOLOGI & ONKOLOGI MEDIK
FK UNAND / RS DR M DJAMIL PADANG
Definition
• Lymph nodes that are abnormal in size,
consistency or number
 Generalized
involvement of 3 or more noncontiguous lymph
node areas.
 Localized
Lymphoid generation
Non Burkitt’s
Lymphocyte
Lymphoplasmocytoid
Plasma cell
Lymph nodes are populated predominantly by
- macrophages,
- dendritic cells,
- B lymphocytes, and
- T lymphocytes.
B lymphocytes are located primarily in the
follicles and perifollicular areas,
T lymphocytes are found primarily in the
interfollicular or paracortical areas of the
lymph node.
Lymphatic System
• Network that filters antigens from the interstitial
•
•
•
•
fluid
Primary site of immune response from tissue
antigens
Lymphatic drainage in all organs of the body except
brain, eyes, marrow and cartilage
600 lymph nodes in body
Slow flow, low pressure system returns interstitial
fluid to the blood system
DIAGNOSIS
Anamnesis
 history
age of the patient
The occurrence of fever, sweats, or
weight
loss
site of infection, a particular medication,
a travel history.
Physical examination
Laboratoric test
Imaging studies to determine the extent and
character of the lymphadenopathy
Histopatologic examination
• In young childrenpalpable lymphadenopathy is the
rule. who are continuously undergoing exposure to new
antigens,
* In fact, the absence of palpable lymphadenopathy
would be considered abnormal
* In adults, lymph nodes larger than 1 to 2 cm in
diameter are generally considered abnormal.
* However, lymph nodes 1 to 2 cm in diameter in the
groin are sufficiently frequent to often be considered
"normal.“
more than two-thirds of patients with LAP have :
nonspecific causes or upper respiratory illnesses
(viral or bacterial),
fewer than 1% have a malignancy
in another study :16% had a malignancy
(lymphoma or metastatic adenocarcinoma)
Thus, the vast majority of patients with
lymphadenopathy will have a nonspecific etiology
requiring few diagnostic tests.
Lymph node character
• Site
• Size
• Consistency
• Pain with palpation
Size
• Greater than one centimeter generally
considered abnormal
• Exception inguinal area, lymph nodes
commonly palpated (>1.5 cm)
• Size does not indicate a specific disease
process
• Obese and thin population
Pain…..
• Indication of rapid increase in size: stretch
of capsular shell
• NOT useful in determining benign vs
malignant state
• Inflammation, suppuration, hemorrhage
Consistency
• Stone hard: typical of cancer usually
metastatic
• Firm rubbery: can suggest lymphoma
• Soft: infection or inflammation
• Suppurated nodes: fluctuant
• Matting
Site
•
Post cervical: scalp, neck skin of arms thorax cervical and axillary nodes (lymphoma, head/neck ca)
MIAMI
MALIGNANT  lymphoma, metastatic
INFECTION  acute, chronic
AUTOIMMUNE DISEASE
MISCELANOUS DISEASE  UNNUSUAL
IATROGENIC
Cancer
• Hematologic malignancies:
 Hodgkins, NHL,
 acute and chronic leukemias,
 multiple myeloma
-
• Metastatic solid tumor
*
*
*
*
head & neck cancer
breast, lung,
gi tract, genitourinary tract cancer
cancer of unknown primary
INFECTION
• Bacterial
• Viral
• Protozoan
• Mycotic
• Rickettsial (typhus)
• Helminthic (filariasis)
Bacterial
• Staph/strep: cutaneous source,
lymphadenitis
• Cat scratch: bartonella hensalae, two
weeks after inoculation
• Mycobacterium: TB and non-tb, host
characteristics
VIRAL
• EBV…mono spot test
• CMV….cmv titers, immunsuppresed,
transplant recipient, recent blood
transfusion
• HIV…IV drug use, high risk sexual
behavior
• Hepatitis….IV drug use
• Herpes Zoster….superficial cutaneous
nodules
Protozoan
• Toxoplasmosis: ELISA assay, intracellular
protozoan toxoplasmosis gondii….bilateral,
symmetrical, non-tender cervical
adenopathy
…consider undercooked meat, reactivation
in immuncompromised host
TERAPHY
ETIOLOGY