Transcript Cervical Lymphadenopathy

Cervical Lymphadenopathy
Cervical lymphadenopathy
Lymphatic cells are present in the whole body
with cells of the hemopoetic sy
 In some tissues higher concentrationlymhonodes, tonsills, spleen, bone, marrow
 Basic function-mechanical filter
-immunological barrier
In ENT area-submental, submandibular, pre-and
retroauricular, before and behind
sternocledomast.muscle, occopital, nuchal,
supra-and infraclavicular lnn.
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Basic investigation
Case history
 Somatic investigation
 Ivestigation of the other organs according
to location of lnn.
 Auxiliary laboratory tests
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Case history
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Age
Job
Sweating
Fewer
Loss of weigh
Local or general infection
Trauma
Itching of the skin
Pain of the joins
Using of the drugs
Contact with animals
Time of enlargment
Somatic investigation of lymph
nodes
Size
 Consistence(abscess, fluctuation, stiffnes,
elasticity)
 Mobility or adherence
 Changes of the skin
 Sensitivity for palpation
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Division of the lymph nodes
Consequence
Liver and spleen
 Inflammation in the areas from tibutary
tissues
 Marks of the symstemic disease(joins)
 Investigation of the nasopharynx,
PNC,pharynx, larynx, tonsils, ear
investigation
 Changes of the skin
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Laboratory tests
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Blood count
Serology(IM,CMV,borrelia, syphillis,
toxoplasmosis)
Microbiology(culture from suspected
areas,haemocolture, TB tests)
X ray of lungs, mediastinum, ultrasound, CT
Diagnostic removal of cerv. Lnn
Histology
Other auxiliary tests(revmatoid factor,HIV antib.,
LE cells, ANF..)
CT
Differential diagnosis
Very wide
 Basic division: Acute
Chronic
1.Inflammatory a.Non specific
b.Specific
2.Neoplastic lymphadenopathy
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Non Specific Lymhadenopathy I
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Very often
Acute painfull swelling
Possible fluctuation
Angina, CMV,Boreliosis,Rubeola
virus,Adenovirus
Revmatoid artritis
Fatigue disease
Dermatopoetic lymphadenopathy
Lymphadenopathy due to drug hypersensitivity
Child with
lymphadenopathy
Lymphadenopathy in
acute tonsillitis
Non Specific Lymphadenopathy II
Benign angiofollicular
lymhoma(Castleman)
 Collagenosis
 Monocutaneous
lymphadenopathy(Kawasaki)
 Sjogren´s disease
 Non malignant idiopatic histiocytosis
 Disturbances of lipid
metabolism(Niemann-Pick´s disease)
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1b.Specific Lymphadenopathy
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TB
Sarcoidosis(Bock´s disease)
Lupus erytematodes
Toxoplasmosis
Cat scratch fever
Tularemia
Anthrax
Syphyllis
Lyme disease
Brucelosis, Actinomycisis, Listeriosis, Leishmaniosis
Cat scratch fever
TB
Tularemia
HIV Lymphadenopathy
2.Neoplastic Lymhadenopathy
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A. Metastases
B.Lymphomas
Differential diagnosis
Medial and lateral cysts, laryngocele, diseases
of thyreoid gland, chemodectoma(carotic body
tumor), neurogenic tumor, cervical lipoma,
hemangioma, lymhangioma(cystic hygroma),
cystadenolymhoma or other tu of salivary
glands,malignant tumours of soft tissues
Hodgkin's Lymphoma
2a.Lymph nodes metastases
Carcinomatous cells reach the peripheral
sinus of the lymph nodes via the afferent
vessels
 Loss of mobility and adherence to
sorrounding tissue due to malignant
infiltration of the capsulae-worse prognosis
 Irregularly spreading of metastases due to
obstructed lymph nodes
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TNM classification
NO-regional lymph nodes are not palpable
 N1-mobile, homolateral enlarged lymph
nodes
 N2-mobile, bilateral or contralateral lymph
nodes
 N3-fixed lymph nodes
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Stage grouping based on TNM
classification for malignant tumors
Melanoma
Neck cancer
Malignant lymhoma
Removal of lymph node