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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