What Is Lymphadenopathy?

Lymph nodes are distributed throughout the body and are important immune organs of the human body. They can be divided into superficial lymph nodes and deep lymph nodes according to their location. Normal lymph nodes are mostly in the range of 0.2 to 0.5%, and they are often distributed in groups. Each group of lymph nodes collects the lymph fluid in the corresponding drainage area, such as the lymph nodes in the scalp area behind the ears and mastoid area; the submandibular lymph node group collects the lymph fluid at the bottom of the mouth, buccal mucosa, gums, etc .; neck Lymph nodes collect the lymph fluid from the nose, pharynx, larynx, trachea, thyroid, etc .; the supraclavicular lymph nodes collect the lymph fluid from the esophagus, stomach and other organs on the left, and collect the lymph fluid from the trachea, pleura, and lungs on the right; axillary lymph node clusters Collect the lymph fluid in the upper trunk, breast, chest wall, etc .; inguinal lymph nodes collect the lymph fluid in the lower limbs and perineum. Understanding the relationship between the two is of great clinical significance in determining the location and nature of the primary lesion.

Basic Information

Visiting department

Department of Infectious Diseases, Oncology

Common causes

Caused by infection or tumor disease

Common symptoms

Localized and systemic lymphadenopathy with fever, pain, etc.

Causes of lymphadenopathy

Infection

Acute and chronic inflammation caused by pathogenic microorganisms, such as bacteria, viruses, rickettsial, etc. cause acute cellulitis, purulent tonsillitis, gingivitis, infectious mononucleosis, roundworm disease, tuberculosis, etc.

Tumor

(1) Lymphoma;

(2) all types of acute and chronic leukemia;

(3) Plasma cell tumors: multiple myeloma, primary macroglobulinemia;

(4) Tumor metastasis: lung cancer, gastric cancer, liver cancer, breast cancer, nasopharyngeal cancer, etc.

3. Reactive hyperplasia

(1) Necrotizing proliferative lymphadenopathy;

(2) Serum disease and serum disease-like reactions;

(3) Allergic subsepticemia;

(4) Systemic lupus erythematosus and rheumatism.

4. Cell proliferation and metabolic abnormalities

(1) Langerhans histiocytosis (histiocytosis X);

(2) Lipid deposition disease;

(3) Sarcoidosis.

Lymphadenopathy

Blood image

The total number and classification of peripheral blood leukocytes have certain reference value for judging the cause of lymphadenopathy. Lymph node enlargement with total white blood cells and neutrophils are common in bacterial infections; lymph node enlargement with normal or decreased white blood cells and lymphocytosis are often considered viral infections; patients with infectious mononucleosis can find heterotypic lymphocytes (10% ~ 20% or more); increased eosinophils suggest parasitic infection or eosinophil granuloma; lymphadenopathy with peripheral blood naive cells are mostly leukemia.

2. Bone marrow examination

Bone marrow smear cell morphology examination, bone marrow pathology examination, bone marrow flow cytometry examination, etc. are decisive for the diagnosis of leukemia and lymphoma.

3. Serology

Such as EBV, CMV IgM, antinuclear antibody spectrum and so on.

4. Lymph node puncture needle smear examination

5. Lymph node pathology

6. Tumor marker detection

If there is a high degree of suspicion of a solid tumor, a tumor marker may be used to assist in diagnosis.

Lymph node enlargement diagnosis

1. A regional lymphadenopathy is called limited lymphadenopathy, which is more common in nonspecific lymphadenitis, lymph node tuberculosis, and malignant tumor metastasis. The primary lesion should be searched according to the area of lymphatic drainage. Lymph node enlargement in more than two areas should be considered as systemic lymph node enlargement. It is more common in acute and chronic lymphadenitis, infectious mononucleosis, leukemia, lymphoma, leptospirosis, ascariasis, brucellosis, Serum disease, connective tissue disease, etc.

2. The accompanying symptoms can provide important clues to the cause of lymphadenopathy.

(1) Patients with enlarged lymph nodes accompanied by infections in the corresponding drainage area, such as submandibular lymphadenopathy with tonsillitis, gingivitis, axillary lymph nodes with mastitis, posterior ear lymph nodes with scalp infection, left inguinal lymph nodes with left Lower extremity erysipelas can be diagnosed as nonspecific lymphadenitis.

(2) Lymphadenopathy accompanied by pain, mostly caused by acute inflammation, often with local inflammation such as redness, swelling, and fever; painless lymphadenopathy is common in malignant lymphomas. Local lymphadenopathy with low fever, night sweats, and weight loss, suggesting lymph node tuberculosis, malignant lymphoma, or other malignant tumors.

(3) Those with enlarged lymph nodes and periodic fever are more common in malignant lymphoma; those with systemic lymphadenopathy and fever are found in infectious mononucleosis, leukemia, and lymphoma, and occasionally seen in systemic lupus erythematosus.

(4) Those with enlarged lymph nodes and rash are more common in certain infectious diseases or allergic diseases, and they need to be alert for lymphoma.

Lymph node enlargement treatment

Corresponding treatment is given according to different causes.