LIMFADENOPATI IRZA WAHID SUBAGIAN HEMATOLOGI & ONKOLOGI MEDIK FK UNAND / RS DR M DJAMIL PADANG FK UNAND / RS DR M DJAMIL PADANG

Definition Lymph nodes that are abnormal in size, consistency or number Lymph nodes that are abnormal in size, consistency or number  Generalized involvement of 3 or more noncontiguous lymph node areas.  Localized

Lymphoid generation Non Burkitt’s Lymphocyte Lymphoplasmocytoid Plasma 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 System Network that filters antigens from the interstitial fluid Network that filters antigens from the interstitial fluid Primary site of immune response from tissue antigens Primary site of immune response from tissue antigens Lymphatic drainage in all organs of the body except brain, eyes, marrow and cartilage Lymphatic drainage in all organs of the body except brain, eyes, marrow and cartilage 600 lymph nodes in body 600 lymph nodes in body Slow flow, low pressure system returns interstitial fluid to the blood system Slow flow, low pressure system returns interstitial fluid to the blood system

D I A G N O S I S Anamnesis  history  age of the patient  The occurrence of fever, sweats, or weight loss  site 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 character Site Site Size Size Consistency Consistency Pain with palpation Pain with palpation

Size Greater than one centimeter generally considered abnormal Greater than one centimeter generally considered abnormal Exception inguinal area, lymph nodes commonly palpated (>1.5 cm) Exception inguinal area, lymph nodes commonly palpated (>1.5 cm) Size does not indicate a specific disease process Size does not indicate a specific disease process Obese and thin population Obese and thin population

Pain….. Indication of rapid increase in size: stretch of capsular shell Indication of rapid increase in size: stretch of capsular shell NOT useful in determining benign vs malignant state NOT useful in determining benign vs malignant state Inflammation, suppuration, hemorrhage Inflammation, suppuration, hemorrhage

Consistency Stone hard: typical of cancer usually metastatic Stone hard: typical of cancer usually metastatic Firm rubbery: can suggest lymphoma Firm rubbery: can suggest lymphoma Soft: infection or inflammation Soft: infection or inflammation Suppurated nodes: fluctuant Suppurated nodes: fluctuant Matting Matting

Site

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 I MALIGNANT  lymphoma, metastatic INFECTION  acute, chronic AUTOIMMUNE DISEASE MISCELANOUS DISEASE  UNNUSUAL IATROGENIC

Cancer Hematologic malignancies: Hematologic malignancies:  Hodgkins, NHL,  acute and chronic leukemias, -  multiple myeloma Metastatic solid tumor Metastatic solid tumor * head & neck cancer * breast, lung, * gi tract, genitourinary tract cancer * cancer of unknown primary

Bacterial Bacterial Viral Viral Protozoan Protozoan Mycotic Mycotic Rickettsial (typhus) Rickettsial (typhus) Helminthic (filariasis) Helminthic (filariasis) I N F E C T I O N

Bacterial Staph/strep: cutaneous source, lymphadenitis Staph/strep: cutaneous source, lymphadenitis Cat scratch: bartonella hensalae, two weeks after inoculation Cat scratch: bartonella hensalae, two weeks after inoculation Mycobacterium: TB and non-tb, host characteristics Mycobacterium: TB and non-tb, host characteristics

VIRAL EBV…mono spot test EBV…mono spot test CMV….cmv titers, immunsuppresed, transplant recipient, recent blood transfusion CMV….cmv titers, immunsuppresed, transplant recipient, recent blood transfusion HIV…IV drug use, high risk sexual behavior HIV…IV drug use, high risk sexual behavior Hepatitis….IV drug use Hepatitis….IV drug use Herpes Zoster….superficial cutaneous nodules Herpes Zoster….superficial cutaneous nodules

Protozoan Toxoplasmosis: ELISA assay, intracellular protozoan toxoplasmosis gondii….bilateral, symmetrical, non-tender cervical adenopathy Toxoplasmosis: ELISA assay, intracellular protozoan toxoplasmosis gondii….bilateral, symmetrical, non-tender cervical adenopathy …consider undercooked meat, reactivation in immuncompromised host

TERAPHY ETIOLOGY