Lymphadenopathy or adenopathy is a
disease
A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...
of the
lymph node
A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that includ ...
s, in which they are abnormal in size or consistency. Lymphadenopathy of an
inflammatory type (the most common type) is lymphadenitis, producing
swollen or enlarged lymph nodes. In clinical practice, the distinction between lymphadenopathy and lymphadenitis is rarely made and the words are usually treated as
synonym
A synonym is a word, morpheme, or phrase that means exactly or nearly the same as another word, morpheme, or phrase in a given language. For example, in the English language, the words ''begin'', ''start'', ''commence'', and ''initiate'' are al ...
ous. Inflammation of the
lymphatic vessel
The lymphatic vessels (or lymph vessels or lymphatics) are thin-walled vessels (tubes), structured like blood vessels, that carry lymph. As part of the lymphatic system, lymph vessels are complementary to the cardiovascular system. Lymph ves ...
s is known as
lymphangitis
Lymphangitis is an inflammation or an infection of the lymphatic channels that occurs as a result of infection at a site distal to the channel. The most common cause of lymphangitis in humans is '' Streptococcus pyogenes'' (Group A strep), hemoly ...
. Infectious lymphadenitis affecting
lymph nodes in the neck is often called
scrofula.
Lymphadenopathy is a common and nonspecific
sign
A sign is an object, quality, event, or entity whose presence or occurrence indicates the probable presence or occurrence of something else. A natural sign bears a causal relation to its object—for instance, thunder is a sign of storm, or ...
. Common causes include
infection
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable di ...
s (from minor causes such as the
common cold
The common cold or the cold is a viral infectious disease of the upper respiratory tract that primarily affects the respiratory mucosa of the nose, throat, sinuses, and larynx. Signs and symptoms may appear fewer than two days after expos ...
and post-vaccination swelling to serious ones such as
HIV/AIDS
Human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV), a retrovirus. Following initial infection an individual ...
),
autoimmune disease
An autoimmune disease is a condition arising from an abnormal immune response to a functioning body part. At least 80 types of autoimmune diseases have been identified, with some evidence suggesting that there may be more than 100 types. Nearly a ...
s, and
cancer
Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...
. Lymphadenopathy is frequently
idiopathic and self-limiting.
Causes
Lymph node enlargement is recognized as a common sign of infectious, autoimmune, or malignant disease. Examples may include:
* Reactive: acute
infection
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable di ...
(''e.g.,''
bacterial
Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were amon ...
, or
viral), or chronic infections (
tuberculous lymphadenitis,
cat-scratch disease
Cat-scratch disease (CSD) or felinosis is an infectious disease that most often results from a scratch or bite of a cat. Symptoms typically include a non-painful bump or blister at the site of injury and painful and swollen lymph nodes. People m ...
).
** The most distinctive sign of
bubonic plague
Bubonic plague is one of three types of plague caused by the plague bacterium ('' Yersinia pestis''). One to seven days after exposure to the bacteria, flu-like symptoms develop. These symptoms include fever, headaches, and vomiting, as wel ...
is extreme swelling of one or more lymph nodes that bulge out of the skin as "buboes." The buboes often become
necrotic and may even rupture.
**
Infectious mononucleosis is an acute viral infection usually caused by
Epstein-Barr virus and may be characterized by a marked enlargement of the
cervical lymph nodes.
** It is also a sign of
cutaneous anthrax
Anthrax is an infection caused by the bacterium ''Bacillus anthracis''. It can occur in four forms: skin, lungs, intestinal, and injection. Symptom onset occurs between one day and more than two months after the infection is contracted. The sk ...
and
Human African trypanosomiasis
African trypanosomiasis, also known as African sleeping sickness or simply sleeping sickness, is an insect-borne parasitic infection of humans and other animals. It is caused by the species ''Trypanosoma brucei''. Humans are infected by two typ ...
**
Toxoplasmosis
Toxoplasmosis is a parasitic disease caused by '' Toxoplasma gondii'', an apicomplexan. Infections with toxoplasmosis are associated with a variety of neuropsychiatric and behavioral conditions. Occasionally, people may have a few weeks or mont ...
, a
parasitic disease, gives a generalized lymphadenopathy (''Piringer-Kuchinka lymphadenopathy'').
[
** Plasma cell variant of Castleman's disease - associated with HHV-8 infection and HIV infection
** ]Mesenteric lymphadenitis
Lymphadenopathy or adenopathy is a disease of the lymph nodes, in which they are abnormal in size or consistency. Lymphadenopathy of an inflammatory type (the most common type) is lymphadenitis, producing swollen or enlarged lymph nodes. In ...
after viral systemic infection (particularly in the GALT in the appendix) can commonly present like appendicitis
Appendicitis is inflammation of the appendix. Symptoms commonly include right lower abdominal pain, nausea, vomiting, and decreased appetite. However, approximately 40% of people do not have these typical symptoms. Severe complications of a r ...
.
Infectious causes of lymphadenopathy may include bacterial infections such as cat scratch disease, tularemia, brucellosis, or prevotella, as well as fungal infections such as paracoccidioidomycosis
Paracoccidioidomycosis (PCM), also known as South American blastomycosis, is a fungal infection that can occur as a mouth and skin type, lymphangitic type, multi-organ involvement type (particularly lungs), or mixed type. If there are mouth ulce ...
.
* Tumoral
A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...
:
** Primary: Hodgkin lymphoma
Hodgkin lymphoma (HL) is a type of lymphoma, in which cancer originates from a specific type of white blood cell called lymphocytes, where multinucleated Reed–Sternberg cells (RS cells) are present in the patient's lymph nodes. The conditio ...
and non-Hodgkin lymphoma
Non-Hodgkin lymphoma (NHL), also known as non-Hodgkin's lymphoma, is a group of blood cancers that includes all types of lymphomas except Hodgkin lymphomas. Symptoms include enlarged lymph nodes, fever, night sweats, weight loss, and tiredne ...
give lymphadenopathy in all or a few lymph nodes.[Status and anamnesis, Anders Albinsson. Page 12]
** Secondary: metastasis
Metastasis is a pathogenic agent's spread from an initial or primary site to a different or secondary site within the host's body; the term is typically used when referring to metastasis by a cancerous tumor. The newly pathological sites, the ...
, Virchow's Node
Supraclavicular lymph nodes are lymph nodes found above the clavicle, that can be felt in the supraclavicular fossa. The supraclavicular lymph nodes on the left side are called Virchow's nodes.[neuroblastoma
Neuroblastoma (NB) is a type of cancer that forms in certain types of nerve tissue. It most frequently starts from one of the adrenal glands but can also develop in the neck, chest, abdomen, or spine. Symptoms may include bone pain, a lump in ...]
, and chronic lymphocytic leukemia
Chronic lymphocytic leukemia (CLL) is a type of cancer in which the bone marrow makes too many lymphocytes (a type of white blood cell). Early on, there are typically no symptoms. Later, non-painful lymph node swelling, feeling tired, fever ...
.
* Autoimmune: systemic lupus erythematosus
Lupus, technically known as systemic lupus erythematosus (SLE), is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body. Symptoms vary among people and may be mild to severe. Commo ...
and rheumatoid arthritis
Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and hands are inv ...
may have a generalized lymphadenopathy.[
* Immunocompromised: ]AIDS
Human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV), a retrovirus. Following initial infection an individual ma ...
. Generalized lymphadenopathy is an early sign of infection with human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS). "Lymphadenopathy syndrome" has been used to describe the first symptomatic stage of HIV progression, preceding a diagnosis of AIDS.
* Bites from certain venomous snake
Venomous snakes are species of the suborder Serpentes that are capable of producing venom, which they use for killing prey, for defense, and to assist with digestion of their prey. The venom is typically delivered by injection using hollow or g ...
s such as the pit viper
The Crotalinae, commonly known as pit vipers,Mehrtens JM (1987). ''Living Snakes of the World in Color''. New York: Sterling Publishers. 480 pp. . crotaline snakes (from grc, κρόταλον ''krotalon'' castanet), or pit adders, are a subfa ...
* Unknown: Kikuchi disease
Kikuchi disease was described in 1972 in Japan. It is also known as histiocytic necrotizing lymphadenitis, Kikuchi necrotizing lymphadenitis, phagocytic necrotizing lymphadenitis, subacute necrotizing lymphadenitis, and necrotizing lymphadenitis. K ...
, progressive transformation of germinal centers
Progressive transformation of germinal centres (PTGCs) is a reactive lymph node process of undetermined cause.
Signs and symptoms
PTGC is usually characterized by localized lymphadenopathy and is otherwise typically asymptomatic.
Diagnosis
PTGC ...
, sarcoidosis
Sarcoidosis (also known as ''Besnier-Boeck-Schaumann disease'') is a disease involving abnormal collections of inflammatory cells that form lumps known as granulomata. The disease usually begins in the lungs, skin, or lymph nodes. Less commonly af ...
, hyaline-vascular variant of Castleman's disease, Rosai-Dorfman disease, Kawasaki disease, Kimura disease
Kimura's disease is a benign rare chronic inflammatory disorder. Its primary symptoms are subdermal lesions in the head or neck or painless unilateral inflammation of cervical lymph nodes.
Cause
Its cause remains unknown. Reasons such as an al ...
Benign (reactive) lymphadenopathy
lymphadenopathy is a common biopsy finding, and may often be confused with malignant lymphoma
Lymphoma is a group of blood and lymph tumors that develop from lymphocytes (a type of white blood cell). In current usage the name usually refers to just the cancerous versions rather than all such tumours. Signs and symptoms may include enla ...
. It may be separated into major morphologic pattern
Morphology, from the Greek and meaning "study of shape", may refer to:
Disciplines
*Morphology (archaeology), study of the shapes or forms of artifacts
*Morphology (astronomy), study of the shape of astronomical objects such as nebulae, galaxies, ...
s, each with its own differential diagnosis
In healthcare, a differential diagnosis (abbreviated DDx) is a method of analysis of a patient's history and physical examination to arrive at the correct diagnosis. It involves distinguishing a particular disease or condition from others that p ...
with certain types of lymphoma. Most cases of reactive follicular hyperplasia
Reactive may refer to:
*Generally, capable of having a reaction (disambiguation)
*An adjective abbreviation denoting a bowling ball coverstock made of reactive resin
* Reactivity (chemistry)
*Reactive mind
*Reactive programming
See also
*Reactan ...
are easy to diagnose, but some cases may be confused with follicular lymphoma
Follicular lymphoma (FL) is a cancer that involves certain types of white blood cells known as lymphocytes. The cancer originates from the uncontrolled division of specific types of B-cells known as centrocytes and centroblasts. These cells norma ...
. There are seven distinct patterns of benign lymphadenopathy:
* Follicular hyperplasia
Follicular hyperplasia (FH) is a type of lymphoid hyperplasia and is classified as a lymphadenopathy, which means a disease of the lymph nodes. It is caused by a stimulation of the B cell compartment and by abnormal cell growth of secondary foll ...
: This is the most common type of reactive lymphadenopathy.
* Paracortical hyperplasia/ Interfollicular hyperplasia: It is seen in viral infections, skin diseases, and nonspecific reactions.
* Sinus histiocytosis
Sinus may refer to:
Anatomy
* Sinus (anatomy), a sac or cavity in any organ or tissue
** Paranasal sinuses, air cavities in the cranial bones, especially those near the nose, including:
*** Maxillary sinus, is the largest of the paranasal sinuses, ...
: It is seen in lymph nodes draining limbs, inflammatory lesions, and malignancies.
* Nodal extensive necrosis
Nodal homolog is a secretory protein that in humans is encoded by the ''NODAL'' gene which is located on chromosome 10q22.1. It belongs to the transforming growth factor beta superfamily (TGF-β superfamily). Like many other members of this sup ...
* Nodal granulomatous inflammation
* Nodal extensive fibrosis (Connective tissue framework)
* Nodal deposition of interstitial substance
Nodal homolog is a secretory protein that in humans is encoded by the ''NODAL'' gene which is located on chromosome 10q22.1. It belongs to the transforming growth factor beta superfamily (TGF-β superfamily). Like many other members of this supe ...
These morphological patterns are never pure. Thus, reactive follicular hyperplasia can have a component of paracortical hyperplasia. However, this distinction is important for the differential diagnosis
In healthcare, a differential diagnosis (abbreviated DDx) is a method of analysis of a patient's history and physical examination to arrive at the correct diagnosis. It involves distinguishing a particular disease or condition from others that p ...
of the cause.
Diagnosis
In cervical lymphadenopathy
Cervical lymphadenopathy refers to lymphadenopathy of the cervical lymph nodes (the glands in the neck). The term ''lymphadenopathy'' strictly speaking refers to disease of the lymph nodes, though it is often used to describe the enlargement of the ...
(of the neck
The neck is the part of the body on many vertebrates that connects the head with the torso. The neck supports the weight of the head and protects the nerves that carry sensory and motor information from the brain down to the rest of the body. In ...
), it is routine to perform a throat examination
A HEENT examination is a portion of a physical examination that principally concerns the head, eyes, ears, nose, and throat.
Steps
* IPPA
** Inspection of scars or skin changes
** Palpation of temporomandibular joint, thyroid, and lymph nodes
** ...
including the use of a mirror
A mirror or looking glass is an object that reflects an image. Light that bounces off a mirror will show an image of whatever is in front of it, when focused through the lens of the eye or a camera. Mirrors reverse the direction of the im ...
and an endoscope.
On ultrasound
Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies ...
, B-mode imaging depicts lymph node morphology, whilst power Doppler
Doppler ultrasonography is medical ultrasonography that employs the Doppler effect to perform imaging of the movement of tissues and body fluids (usually blood), and their relative velocity to the probe. By calculating the frequency shift of a ...
can assess the vascular pattern. B-mode imaging features that can distinguish metastasis
Metastasis is a pathogenic agent's spread from an initial or primary site to a different or secondary site within the host's body; the term is typically used when referring to metastasis by a cancerous tumor. The newly pathological sites, the ...
and lymphoma
Lymphoma is a group of blood and lymph tumors that develop from lymphocytes (a type of white blood cell). In current usage the name usually refers to just the cancerous versions rather than all such tumours. Signs and symptoms may include en ...
include size, shape, calcification, loss of hilar architecture, as well as intranodal necrosis. Soft tissue edema and nodal matting on B-mode imaging suggests tuberculous cervical lymphadenitis or previous radiation therapy
Radiation therapy or radiotherapy, often abbreviated RT, RTx, or XRT, is a therapy using ionizing radiation, generally provided as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator. Rad ...
. Serial monitoring of nodal size and vascularity are useful in assessing treatment response.
Fine needle aspiration cytology (FNAC) has sensitivity and specificity
''Sensitivity'' and ''specificity'' mathematically describe the accuracy of a test which reports the presence or absence of a condition. Individuals for which the condition is satisfied are considered "positive" and those for which it is not are ...
percentages of 81% and 100%, respectively, in the histopathology
Histopathology (compound of three Greek words: ''histos'' "tissue", πάθος ''pathos'' "suffering", and -λογία '' -logia'' "study of") refers to the microscopic examination of tissue in order to study the manifestations of disease. Sp ...
of malignant cervical lymphadenopathy. PET-CT has proven to be helpful in identifying occult primary carcinomas of the head and neck, especially when applied as a guiding tool prior to panendoscopy, and may induce treatment related clinical decisions in up to 60% of cases.
Classification
Lymphadenopathy may be classified by:
* Size, where lymphadenopathy in adults is often defined as a short axis of one or more lymph nodes is greater than 10mm.
* By extent:
** ''Localized lymphadenopathy'': due to localized spot of infection e.g., an infected spot on the scalp will cause lymph nodes in the neck on that same side to swell up
** Generalized lymphadenopathy
Generalized lymphadenopathy is swollen lymph glands in many areas of the body.
Usually this is in response to a body-wide infectious disease such as influenza and will go away once the person has recovered, but sometimes it can persist long-ter ...
: due to a systemic infection of the body e.g., influenza or secondary syphilis
Syphilis () is a sexually transmitted infection caused by the bacterium '' Treponema pallidum'' subspecies ''pallidum''. The signs and symptoms of syphilis vary depending in which of the four stages it presents (primary, secondary, latent, a ...
*** Persistent generalized lymphadenopathy
Persistent generalized lymphadenopathy (PGL) is enlarged, painless, non-tender lymph nodes occurring in a couple of different areas for more than three to six months for which no other reason can be found. To expand, the common site where PGL occur ...
(PGL): persisting for a long time, possibly without an apparent cause
* By localization:
** Hilar lymphadenopathy.
** Mediastinal lymphadenopathy
Mediastinal lymphadenopathy or mediastinal adenopathy is an enlargement of the mediastinal lymph nodes.
Causes
There are many possible causes of mediastinal lymphadenopathy, including:
*Tuberculosis
*Sarcoidosis
*Lung cancer/oesophageal cancer
* ...
** Bilateral hilar lymphadenopathy
Bilateral hilar lymphadenopathy is a bilateral enlargement of the lymph nodes of pulmonary hila. It is a radiographic term for the enlargement of mediastinal lymph nodes and is most commonly identified by a chest x-ray.
Causes
The following a ...
* Dermatopathic lymphadenopathy
In pathology, dermatopathic lymphadenopathy, is lymph node pathology due to skin disease.
Cause
Also known as lipomelanotic reticulosis or Pautrier-Woringer disease, represents a rare form of benign lymphatic hyperplasia associated with most exfo ...
: lymphadenopathy associated with skin disease.
* By malignancy: Benign lymphadenopathy is distinguished from malignant types which mainly refer to lymphoma
Lymphoma is a group of blood and lymph tumors that develop from lymphocytes (a type of white blood cell). In current usage the name usually refers to just the cancerous versions rather than all such tumours. Signs and symptoms may include en ...
s or lymph node metastasis
Metastasis is a pathogenic agent's spread from an initial or primary site to a different or secondary site within the host's body; the term is typically used when referring to metastasis by a cancerous tumor. The newly pathological sites, the ...
.
Size
* By size, where lymphadenopathy in adults is often defined as a short axis of one or more lymph nodes is greater than 10mm. However, there is regional variation as detailed in this table:
Lymphadenopathy of the axillary lymph nodes can be defined as solid nodes measuring more than 15 mm without fatty hilum.[Page 559]
in: Axillary lymph nodes may be normal up to 30 mm if consisting largely of fat.[
In children, a short axis of 8 mm can be used. However, inguinal lymph nodes of up to 15 mm and cervical lymph nodes of up to 20 mm are generally normal in children up to age 8–12.][ Last checked: 24 March 2014]
Lymphadenopathy of more than 1.5–2 cm increases the risk of cancer
Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...
or granulomatous disease
A granuloma is an aggregation of macrophages that forms in response to chronic inflammation. This occurs when the immune system attempts to isolate foreign substances that it is otherwise unable to eliminate. Such substances include infectiou ...
as the cause rather than only inflammation
Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molec ...
or infection
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable di ...
. Still, an increasing size and persistence over time are more indicative of cancer.
See also
* Adenitis
* Lymphovascular invasion
Lymphovascular invasion (LVI or lymphovascular space invasion) is the invasion of a cancer to the blood vessels and/or lymphatics.
Terminology
Lymph: A clear or white fluid that travels through vessels, moves within tissues and work to keep all ...
References
External links
HPC:13820
on humpath.com (Digital slides)
{{Bacterial cutaneous infections
Cytopathology
Inflammations
Diseases of veins, lymphatic vessels and lymph nodes