What is Lymphadenopathy?

Lymph node swelling may be detected during the physical exam, in areas such as the axillae, or armpits, or neck and groin regions. Image Source/Image Source/Getty Images

Lymphadenopathy: Disease or Enlargement of Lymph Nodes

Lymph nodes are small round structures that are present all over the body. They provide a house or enclosure for cells -- most commonly white blood cells -- that are involved in protecting the human body from infections.

Lymphadenopathy can occur for a number of reasons, including the following:

·      Infections—the most common reason

·      Lymphomas and leukemias—cancers of white blood cells

·      Cancers at other sites that spread to lymph nodes

·      Diseases of the immune system, such as lupus and sarcoidosis

·      A long list of many other uncommon diseases.

The neck, armpits, and groin are the body parts where enlarged lymph nodes are most easily felt. The appearance of lumps in these areas is the most common sign of lymphadenopathy.

When the cause of lymphadenopathy is not clear, doctors may advise having tests such as fine needle aspiration cytology, or FNAC. In the case of initial diagnosis of lymphoma, a lymph node biopsy -- the removal of part or all of a lymph node for testing and analysis -- is required.

The treatment of lymphadenopathy depends on the reason for lymph node enlargement.

Why Do Lymph Nodes Swell?

Doctors view lymph node enlargement differently depending on the signs and symptoms that come along with swollen lymph nodes. Sometimes it is clear that swollen lymph nodes are due to an infection.

For example, enlarged lymph nodes along the neck can be a common feature of infectious mononucleosis, a disease caused by the Epstein-Barr virus. Other times, swollen lymph nodes can by more mysterious and need to be investigated. Here are some frequently asked questions about swollen lymph nodes:

·      Do lymph nodes ever swell for no reason?

·      I Have a swollen lymph node. Is it lymphoma?

·      What’s the most common cause of swollen glands?

·      How can I tell if it’s a lymph node or something else?

Are There Different Types of Lymphadenopathy?

Lymphadenopathy can have additional descriptors, depending on where in the body the lymph nodes are swollen. Some examples and their relevance to leukemia and lymphoma follow.

Cervical Lymphadenopathy

Cervical lymph node swelling refers to enlarged lymph nodes in the neck region. This is a very common feature of viral infections. Less commonly, swollen lymph nodes in the neck can be a sign of malignancy. Children with Hodgkin disease present with cervical adenopathy in 80-90 percent of cases as opposed to 40 percent of those with non-Hodgkin lymphoma.

Mediastinal Lymphadenopathy

Mediastinal lymphadenopathy occurs in the mediastinum. Mediastinum is an anatomical term that can be thought of as an imaginary box, or container, and also to all of the box’s contents. Imagine a cube, bordered on two sides by the lungs; two sides by the breastbone and backbone; at the top by the outlet to the neck; and at the bottom by the chest floor, or diaphragm muscle used in breathing.

Mediastinal lymph nodes can become enlarged on their own, or along with diseases of the lungs. Hodgkin lymphoma, or HL, often starts with the mediastinal lymph nodes. Non-Hodgkin lymphoma, or NHL, can arise in the mediastinal lymph nodes, too; however, NHL often has a different pattern of lymph node involvement and spread.

What is Generalized Lymphadenopathy?

When there are more than two nodes involved from different areas, this is called generalized lymphadenopathy. Involvement of different areas can be a clue as to which diseases might be responsible. Generalized lymphadenopathy is found in two-thirds of children diagnosed with acute lymphoblastic leukemia (ALL) and in one third of children with acute myeloblastic leukemia (AML).

Hodgkin's disease, a type of lymphoma, is just one possible cause of generalized lymphadenopathy, but students sometimes use the following memory device to learn this long list of potential causes:

H. Hematologic: Hodgkin’s disease, leukemia, and non-Hodgkin’s lymphoma

O. Oncologic: Metastasis to lymph node, malignant melanoma

D. Dermatopathic lymphadenitis: swollen lymph nodes that drain a patch of skin that has been disrupted or irritated

G. Gaucher’s disease: a rare genetic disease

K. Kawasaki’s disease: a rare autoimmune disease involving the blood vessels and inflammation

I. Infections: bacterial, viral, and parasitic

N. Niemann–pick disease: a genetic disease that involves metabolism

S. Serum sickness: an immune response to certain medications or treatments

 

D. Drug reaction: response to certain drugs

I. Immunological disease: for example, rheumatoid arthritis and lupus

S. Sarcoidosis: an inflammatory disease that can affect different parts of the body

E. Endocrine: hyperthyroidism

A. Angioimmunoplastic lymphadenopathy: this is an old term; currently considered a lymphoma.

S. Systemic lupus erythematosus (lupus, or SLE)

E. Eosinophilic granulomatosis: a systemic disease involving allergic and inflammatory manifestations

 

Sources:

Lymphadenopathy and Malignancy. http://www.aafp.org/afp/2002/1201/p2103.html.

Mnemonics In Internal Medicine & Pediatrics. Parmar HB. B. Jain Publishers.

Agostinelli C, Pileri S. Pathobiology of Hodgkin Lymphoma. Mediterr J Hematol Infect Dis. 2014;6(1):e2014040.

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