Lymphadenopathy

doi:10.4065/75.7.723

Mayo Clinic Proceedings

Volume 75, Issue 7, July 2000, Pages 723-732

https://doi.org/10.4065/75.7.723 Get rights and content

Lymphadenopathy can occur in any age group, in symptomatic or asymptomatic patients, and in a single site or at multiple sites. Lymphadenopathy is associated with numerous disorders. An abnormal lymph node may be observed or palpated by the patient, found by a health care worker, or discovered through radiologic evaluation. Lymphadenopathy may be a part of a complex case presentation, or the clinical cause may be straightforward. Patients with potentially curable malignant disorders may have lymphadenopathy as the first sign of their disease. This review of lymphadenopathy summarizes general considerations, discusses which patients might be considered for biopsy, reviews which nodes are most likely to be diagnostic, outlines initial diagnostic considerations on a region by-region basis, and reviews a broad differential diagnosis for adenopathy.

Section snippets

Patient Age, Node Size, And Node Location

Age is the most important factor in predicting the probability of whether the lymphadenopathy is due to a benign or malignant lesion.¹ Lee et al¹ analyzed findings from 925 patients who underwent a lymph node biopsy at Los Angeles County Hospital between 1973 and 1977 (Table 2). This total represented 0.9% of all surgical cases at the institution during that period. Lymphoproliferative disorders were not found to have an age predilection, while carcinomas, predictably, were much more common in

Differential Diagnosis

The differential diagnosis of lymphadenopathy of unknown origin is similar to that of fever of unknown origin or an elevated erythrocyte sedimentation rate, in that most cases are due to an infection, a malignancy, or an immune disorder.³³ There are 3 broad models to categorize lymphadenopathy. The extensive differential diagnosis may be grouped incorporating an acronym, CHICAGO (cancers, hypersensitivity syndromes, infections, connective tissue diseases, atypical lymphoproliferative disorders,

Special Clinical And Laboratory Associations

Historical and laboratory associations may aid in establishing the diagnosis in difficult cases associated with lymphadenopathy (Table 6). The differential diagnosis of lymphadenopathy with malabsorption includes gluten-sensitive enteropathy, Crohn disease, amyloidosis, and Whipple disease. Rheumatoid arthritis, systemic lupus erythematosus, Wegener granulomatosis, or Whipple disease may cause lymphadenopathy associated with arthralgias or arthritis. Renal disease and lymphadenopathy are seen

Conclusion

Lymphadenopathy is an important physical finding with an extensive differential diagnosis that often presents interesting challenges to the clinician. Skill in palpating peripheral lymph nodes improves with time. Clinicians should be encouraged to consistently measure the peripheral nodes that are discovered on physical examination with calipers. Node biopsies, when appropriate, should be performed in a manner most likely to yield a useful result. Knowledge of the broad differential diagnosis

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Cervical lymph node biopsies in the evaluation of children with suspected lymphoproliferative disorders: Experience in a tertiary pediatric setting
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The objectives of this study were: (1) to determine the incidence of lymphoproliferative disorders in a cohort of patients requiring a biopsy at a tertiary pediatric center; and (2) to elucidate the demographic, clinical, laboratory and diagnostic imaging characteristics associated with a malignant diagnosis.
A retrospective review of pediatric cervical lymph node biopsies performed between 2012 and 2019 at a tertiary center was undertaken. Demographic data, clinical presentations, laboratory results, diagnostic imaging findings, and pathology results were compiled and analyzed to identify characteristics associated with a malignant diagnosis.
Malignancy was identified in 49.5% of patients (55/111) subjected to a cervical lymph node biopsy. The median age of patients with a benign diagnosis was lower than malignant diagnosis (11.0 vs. 14.0 years, p < 0.01). Mediastinal lymphadenopathy based on chest radiography and/or computed tomography scan was identified in 37/49 malignant cases (75.5%)
In this retrospective study, 49.5% of biopsies performed at a tertiary pediatric setting yielded a malignant diagnosis. Traditional clinical characteristics such as weight loss, night sweats and nodal texture were not informative when derived retrospectively. The most valuable features identified were increased age, increased long and short axis measurements of the involved node(s), and the presence of mediastinal lymphadenopathy.
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Isolated humeral tuberculosis lymphadenitis in healthy woman: Case report
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Citation Excerpt :
One of its epidemiological features is that the ratio of infection of females to Males is 1.4:1, with a peak incidence between the third and fourth decades and the patient often comes with a history of cervical lymphadenopathy Without pain [3]. The most location place for the disease to occur is in the Cervical nodes, but its diagnosis may be difficult because it is similar to Many other benign and malignant diseases (sarcoid, unspecified Hyperplasia, malignant lymphoma, etc …) [4]. It is associated with other systemic symptoms such as fever, fatigue or weight loss and night Sweats, which are not specific as they can occur with other diseases [5].
Pulmonary tuberculosis is a disease that may effect on many organs such as the lung, peritoneum and spread to adjacent lymph nodes in advanced stages, but it is rarely to be as an isolated lymph node without accompanying pulmonary or extra pulmonary tuberculosis in healthy persons.
A 40 –Years-female presented with a chief complaint of Pain in the lateral side of the Right humerus above the elbow, with no medical history, on clinical examination there was a painful palpable mass in mentioned place. The mass was removed surgically under local anesthesia and sent for pathological autopsy. The result of the pathological autopsy was tuberculosis lymphadenitis. After that, the patient has been sent to a specialized center for tuberculosis to receive the suitable treatment.
More studies should be done to investigate the potential causes of these unusual cases and finding the accurate physiological mechanisms that inhibit the usual manifestations of tuberculosis in these patients to avoid advanced complications.
Isolated tuberculosis lymphadenitis in healthy persons is unusual case in the literature, which the clinical doctors should be careful in examination the patients who admitting with abnormal lymph nodes and unknown history exposure to tuberculosis. .
Evaluation of the predictive role of neutrophil/lymphocyte ratio in the diagnosis of lymphoma in patients with asymptomatic and ısolated cervical lymphadenopathy
2021, Brazilian Journal of Otorhinolaryngology
The diagnostic approach to patients with isolated asymptomatic cervical lymphadenopathy varies between excisional biopsy and follow-up. When the anamnesis, physical examination, laboratory and imaging findings are not sufficient to identify the etiology, an excisional biopsy is performed for the differential diagnosis between early-stage lymphoma and infectious or reactive causes. If the excisional biopsy, which may have some complications, is not performed, it may delay the diagnosis of lymphoma. This diagnostic challenge could be avoided by predictive markers.
This study was planned to determine the predictive value of neutrophil/lymphocyte ratio in the diagnosis of Hodgkin and non-Hodgkin limphoma in patients with asymptomatic, isolated cervical limphadenopathy and underwent excisional biopsy.
A total of 90 patients between the years 2016 − 2019 admitted to our clinics due to asymptomatic isolated cervical lymphadenopathy, present in at least 4 weeks with lympho nodes in pathological dimensions persisting in the cervical region, were included to our study. An excisional lympho node biopsy was performed in all 90 patients.
Of the 90 patients who underwent excisional biopsy; 34 were diagnosed as reactive lymphadenopathy 30 were non-Hodgkin linphoma, and 26 were Hodgkin linphoma. A total of 56 (62.2%) patients were diagnosed as lymphoma, either Hodgkin or non-Hodgkin, while 34 patients (38.8%) were diagnosed as reactive lymphadenopathy. The median age, total whiteblood count, neutrophil count of the lymphoma groups were significantly higher than reactive lymphadenopathy group, whereas the lymphocyte count was significantly lower in the lymphoma patients. The median neutrophil/ lymphocyte ratio was 1.7 in the reactive lymphadenopathy group, 3.5 in the non-Hodgkin limphoma group, and 3.0 in the Hodgkin limphoma group (p < 0.001).
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Tuberculous lymphadenitis (TBLA) is the most common extrapulmonary manifestation of tuberculosis (TB) in Denmark. However, the clinical features of patients with TBLA have never been systematically studied in this setting.
Patients treated for TBLA in Central Region Denmark from 2007 to 2016 were identified using the national TB surveillance register and The Danish Hospital Patient Registry. Data of clinical characteristics and treatment were extracted from hospital records.
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Subspecialty Clinics: HematologyLymphadenopathy

Section snippets

Patient Age, Node Size, And Node Location

Differential Diagnosis

Special Clinical And Laboratory Associations

Conclusion

iMncei

Ann Allergy Asthma Immunol

Lancet

J Pediatr

Clin Radiol

AmJ Pathol

Am J Med

Am J Med

Am J Med

J Am AcadDermalol

Lymph node biopsy for diagnosis: a slalistical study

J Sui-g Oncol

fcpslcin-Barr virus [alenl membrane protein expression by Hodgkin and Reed-Sternbcrg-like cells in acute infectious mono-nuclcosis

JAMA

Lymphadenopathy due to infectious mononuctcosis: ils confusion with malignant lymphoma

Cancer

Lymphadenopathy morphologically consistent with Hodgkin's disease associated with Epstein-Barr virus infection

Am J Clin Palhol

Infectious mononucleosis and Hodgkin's disease

Int J Cancer

Clinical approach to lymphadenopathy

Semin Oncol

Upper abdominal lymph nodes: criteria for normal size determined with CT

Radiology

Abdominal lymphadenopathy: spectrum of CT findings

Radiographies

Normal mediastinal lymph nodes: number and size according to American Thoracic Society mapping

AJR Am J Roentgenol

The number and size of normal mediastinal lymph nodes: a postmortem study

AJR Am J Roentgenol

Enlarged cervical lymph nodes at helical CT

Radiology

J Clin Oncol

When to perform biopsies of enlarged peripheral lymph nodes in young patients

JAMA

Staging for Hodgkin's disease

Semin Oncol

Rare syndromes in Hodgkin's disease

Ann Oncol

Splenomegaly and solitary spleen metastasis in solid tumors

Cancer

To improve the yield of biopsy of the lymph nodes

Surg Gynecol Obstet

Diagnosis and treatment of iatrogenic spinal accessory nerve injury

Am Surg

Complications of biopsy of the cervical lymph node

Surg Gynecol Obstet

Reliability and limitations of fine needle aspiration cytology of lymphadenopathies: an analysis of 1,261 cases

ActaCylol

Needle biopsy in malignant lymphoma [editorial]

J CimOncot

Image-guided core-needle biopsy in malignant lymphoma: expérience with 100 patients that suggests the technique is reliable

J Clin Oncol

Role of image-guided core-needle biopsy in the management of patients with lvmpho-ma

J Clin Oncol

Biopsy of enlarged, superficial lymph nodes

JAMA

Non-malignant lymphadenopathics; reactive non-specific and reactive specific

The fate of patients with nondiagnostic lymph node biopsies

Surgery

The fate of patients with nondiagnostic lymph node biopsies

CA Cancer J Clin

Diagnosis of malignant lymphoma: aclinicopalhological analysis of 158 different lymph node biopsies

Cancer

Atypical hypcrplasia of lymph nodes: a follow-up study

Cancer

Immunophenotypic and immunogenotypic approaches useful in distinguishing benign and malignant lymphoid proliferations

Semin Oncol

Rapid immunotyping of B-cell non-Hodgkm's lymphomas by flow cytometry: a comparison with the standard frozen-section method

Am J Clin Pathtil

Diagnostic approach to malignant and nonmalignant disorders of the hcmatapoiclic-lymphoid system

Approach lb the patient with suspected lymphoma

Lymph node pathology of acquired immunodeficiency syndrome (AIDS)

Ann Clin Lab Sei

Subspecialty Clinics: Hematology
Lymphadenopathy