LIMFADENOPATILIMFADENOPATI

IRZA WAHIDIRZA WAHIDSUBAGIAN HEMATOLOGI & ONKOLOGI MEDIKSUBAGIAN HEMATOLOGI & ONKOLOGI MEDIK

FK UNAND / RS DR M DJAMIL PADANGFK UNAND / RS DR M DJAMIL PADANG

DefinitionDefinition

•Lymph nodes that are abnormal in Lymph nodes that are abnormal in size, consistency or numbersize, consistency or number

Generalized Generalized involvement of 3 or more noncontiguous involvement of 3 or more noncontiguous

lymph node areas.lymph node areas.

LocalizedLocalized

Lymphoid generationLymphoid generation

Non Burkitt’sLymphocyte

LymphoplasmocytoidPlasma 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 SystemLymphatic System

• Network that filters antigens from the Network that filters antigens from the interstitial fluidinterstitial fluid

• Primary site of immune response from tissue Primary site of immune response from tissue antigensantigens

• Lymphatic drainage in all organs of the body Lymphatic drainage in all organs of the body except brain, eyes, marrow and cartilageexcept brain, eyes, marrow and cartilage

• 600 lymph nodes in body600 lymph nodes in body

• Slow flow, low pressure system returns Slow flow, low pressure system returns interstitial fluid to the blood systeminterstitial fluid to the blood system

D I A G N O S I S

Anamnesis history age of the patientThe occurrence of fever, sweats, or weight losssite 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 characterLymph node character

• SiteSite

• SizeSize

• ConsistencyConsistency

• Pain with palpationPain with palpation

SizeSize

• Greater than one centimeter Greater than one centimeter generally considered abnormalgenerally considered abnormal

• Exception inguinal area, lymph nodes Exception inguinal area, lymph nodes commonly palpated (>1.5 cm)commonly palpated (>1.5 cm)

• Size does not indicate a specific Size does not indicate a specific disease processdisease process

• Obese and thin populationObese and thin population

Pain…..Pain…..

• Indication of rapid increase in size: Indication of rapid increase in size: stretch of capsular shellstretch of capsular shell

• NOT useful in determining benign vs NOT useful in determining benign vs malignant statemalignant state

• Inflammation, suppuration, Inflammation, suppuration, hemorrhagehemorrhage

ConsistencyConsistency

• Stone hard: typical of cancer usually Stone hard: typical of cancer usually metastaticmetastatic

• Firm rubbery: can suggest lymphomaFirm rubbery: can suggest lymphoma

• Soft: infection or inflammationSoft: infection or inflammation

• Suppurated nodes: fluctuantSuppurated nodes: fluctuant

• MattingMatting

SiteSite

• Post cervical: scalp, neck skin of arms thorax cervical and axillary nodes (lymphoma, head/neck ca)Post cervical: scalp, neck skin of arms thorax cervical and axillary nodes (lymphoma, head/neck ca)

M I A M IM I A M I

MMALIGNANT ALIGNANT lymphoma, lymphoma, metastaticmetastatic

IINFECTION NFECTION acute, chronicacute, chronic

AAUTOIMMUNE DISEASEUTOIMMUNE DISEASEMMISCELANOUS DISEASE ISCELANOUS DISEASE

UNNUSUAL UNNUSUAL

IIATROGENICATROGENIC

CancerCancer• Hematologic malignancies: Hematologic malignancies:

Hodgkins, NHL, Hodgkins, NHL,

acute and chronic leukemias, acute and chronic leukemias, -- multiple myeloma multiple myeloma

• Metastatic solid tumor Metastatic solid tumor

* head & neck cancer * head & neck cancer

* breast, lung, * breast, lung,

* gi tract, genitourinary tract * gi tract, genitourinary tract cancercancer

* cancer of unknown primary* cancer of unknown primary

• BacterialBacterial

• ViralViral

• ProtozoanProtozoan

• MycoticMycotic

• Rickettsial (typhus)Rickettsial (typhus)

• Helminthic (filariasis)Helminthic (filariasis)

I N F E C T I O NI N F E C T I O N

BacterialBacterial

• Staph/strep: cutaneous source, Staph/strep: cutaneous source, lymphadenitislymphadenitis

• Cat scratch: bartonella hensalae, two Cat scratch: bartonella hensalae, two weeks after inoculationweeks after inoculation

• Mycobacterium: TB and non-tb, host Mycobacterium: TB and non-tb, host characteristicscharacteristics

VIRALVIRAL

• EBV…mono spot testEBV…mono spot test

• CMV….cmv titers, immunsuppresed, CMV….cmv titers, immunsuppresed, transplant recipient, recent blood transplant recipient, recent blood transfusiontransfusion

• HIV…IV drug use, high risk sexual behaviorHIV…IV drug use, high risk sexual behavior

• Hepatitis….IV drug useHepatitis….IV drug use

• Herpes Zoster….superficial cutaneous Herpes Zoster….superficial cutaneous nodulesnodules

ProtozoanProtozoan

• Toxoplasmosis: ELISA assay, Toxoplasmosis: ELISA assay, intracellular protozoan toxoplasmosis intracellular protozoan toxoplasmosis gondii….bilateral, symmetrical, non-gondii….bilateral, symmetrical, non-tender cervical adenopathytender cervical adenopathy

……consider undercooked meat, consider undercooked meat, reactivation in immuncompromised reactivation in immuncompromised hosthost

TERAPHYTERAPHY

ETIOLOGYETIOLOGY