2. Lymphadenopathy -
pathophysiology
Lymph node enlargement may occur via any of the following mechanisms:
Nodal cells may replicate in response to antigenic stimulation or malignant
transformation (e.g., lymphoma).
Large number of reactive cells from outside node (e.g., neutrophils or metastatic cells)
may enter node.
Foreign material may be deposited into node by lipid-laden histiocytes (e.g., lipid
storage diseases).
Vascular engorgement and edema may occur secondary to local cytokine release.
Suppuration secondary to tissue necrosis (e.g., Mycobacterium tuberculosis)
4. Generalized adenopathy has been
defined as
involvement of three or more
noncontiguous lymph node areas.
generalized lymphadenopathy is frequently
associated with nonmalignant disorders
5. 1.Common infectious causes:
Bacterial
Group A streptococcus
Mycobacteria: typical and atypical
Anaerobic bacteria
Diphtheria
Brucellosis
Actinomycetes
Gram –ve enterios
8. 2.Immunologic diseases.
a. Rheumatoid arthritis
b. Juvenile rheumatoid arthritis
c. Mixed connective tissue disease
d. Systemic lupus erythematosus
e. Dermatomyositis
f. Sjögren’s syndrome
g. Serum sickness
12. 6. Other disorders
a. Castleman’s disease (giant lymph node
hyperplasia)
b. Sarcoidosis
c. Dermatopathic lymphadenitis
d.Histiocytic necrotizing lymphadenitis
e. Sinus histiocytosis with massive lymphadenopathy
f. Mucocutaneous lymph node syndrome (Kawasaki’s
disease
13. g. Familial Mediterranean fever
h. Severe hypertriglyceridemia
i. Vascular transformation of
sinuses
j. Inflammatory pseudotumor of
lymph node
14. Few causes of large nodes
Lymphangitis
Acute
Suppurative-staphylococci most common cause-mode is firm and tender,
erythematous and swollen
Cat Scratch- most common cause, node lasting longer than 3 wks. Found in
any nodes, large, red, tender
Hodgkin- malignant nodes matted, firm, rubbery, asymmetry is the rule
Non-Hodgkin-malignant-well defined and solid, nontender
Lymphadenitis – node it’s self is infected- one node enlarged, red ,
warm, tender- no streaking
17. The causes of lymphadenopathy is broad. A patient's
medical history and review of systems is important in
narrowing this differential. Upon
examination, recognizing the pattern of lymph
drainage aids in seeking an infectious focus.