Lymphadenopathy
Summary/Definition
A pathological situation characterized by enlarged lymph nodes is called lymphadenopathy. Lymphadenopathy is a condition for which the causes are still unknown (meaning they rarely manifest). It can be caused by various factors, such as the development of cancer cells, purulent abscesses, or inflammation. The causes of lymphadenopathy vary according to age and gender. In children and young adults, lymphadenopathy is more often caused by bacterial and viral infections; their immune systems often successfully deal with these infections. However, as they get older and their age increases, more risk factors can cause lymphadenopathy, including unwanted exposure to medications, as well as cancer-promoting factors such as alcohol consumption and smoking. Lymphadenopathy can be categorized as local (LAP) or regional (RAP), depending on which part of the body it occurs in. Local lymphadenopathy is most commonly seen in the neck region and can be caused by various causes, such as tuberculous lymphadenitis or Kikuchi-Fujimoto disease, which can be hyperplastic or suppurative. Tuberculous lymphadenitis most commonly occurs in individuals between the ages of two and forty and is caused by infection with the tubercle bacillus. This condition can manifest in different areas of the neck, including the supraclavicular area, the area in front of the eardrum and under the chin. Symptoms can vary depending on location and can include pain, or no pain at all. As the disease continues, it is sometimes necessary to puncture the capsule of the lymph node to drain the purulent contents. During further progression of the disease, the lymph node continues to enlarge, passing through the stage of exacerbation, which is accompanied by general symptoms such as weight loss, increased body temperature, deterioration of appetite, feeling of exhaustion and other similar manifestations. If the disease progresses further, it may be necessary to puncture the capsule of the lymph node in its central part to facilitate drainage and prevent the development of pancreonecrosis (tissue decomposition) of the lymph node.
Also, in complications due to secondary bacterial infection, there is a rupture of the skin resulting in an effusion to the surface and an alternative route for drainage may be formed if there are complications. In cases of secondary infection, this is also accompanied by lymph node rupture and possible pain and swelling. Diagnosis usually involves tissue biopsy and fine-needle aspiration biopsy followed by cytological examination (fine-needle aspiration cytology).
Hyperplastic and suppurative lymphadenitis, also known as Kikuchi-Fujimoto’s disease, is a common condition that most commonly occurs in young Asian women under the age of 30. The causes of this disease are still not fully understood. The acute and subacute course of the disease usually lasts from 1 to 3 weeks and is characterized by pain in the area of the lymph nodes, which can range in size from 0.5 to 4 cm. Patients may also experience increased body temperature, symptoms of respiratory failure, night sweats, laryngitis, weight loss, nausea, vomiting, skin rashes and other symptoms. Excisional biopsy, ultrasound biopsy, lymph node biopsy and blood tests are used to diagnose this disease. A characteristic sign of this pathology is a decrease in the level of leukocytes in the blood. Reactive lymphadenitis is often the cause of cervical lymph node disease, often accompanied by symptoms of sore throat or preceded by influenza. This condition usually presents with bilateral lymph node involvement and is more common in children and young adults.
A viral or bacterial infection, judging from the clinical manifestations, is quite difficult to attribute to either Kikuchi-Fujimoto disease or tuberculous lymphadenitis. In the case of non-specific lymphadenitis, in reactive lymphadenitis, it is often unnecessary to undergo all available tests.
The cervical metastatic cancer is a pathology in which primary cancer cells from other organs metastasize to the lymph nodes of the neck. In adults over 40 years of age, this condition is characterized by a persistent course. Therefore, it is recommended to undergo a complete medical examination to ensure that the lump in the neck lymph node is not metastatic, also ruling out the possibility of other neoplasms or lymphoma.
In most patients, cancer metastasizes to lymph nodes, usually in the mouth, head, salivary glands and other locations in the neck and head. It may also metastasize to the collarbone and lower neck.
Symptoms
The symptoms of lymphadenitis in the neck area can manifest themselves in a variety of pieces ways. When palpating the mass, patients may feel pain and tension in the throat. Other common symptoms may include fatigue, increased body temperature, cold sweating, weight loss, etc. However, in rare cases, the lump may not be noticeable on palpation and may present without symptoms. In lymphadenitis, pain is often present on palpation, but sometimes it may be absent, depending on the situation. Symptoms in the neck area associated with enlarged lymph nodes can be similar to lymphadenitis, but can also be associated with malignant tumours. In these cases, patients may experience weight loss and feel a thickening that may be painless even on palpation. In addition, skin rashes may occur as a result of skin irritation by pathogens.
Diagnostics
A variety of pieces information should be collected when interviewing the patient. This information includes age, medical history, size and location of the lesion, duration of symptoms, extent of spread, and associated symptoms. It is important to consider the patient’s sensations when palpating the enlarged lymph node, their nature, intensity and other aspects. It is also important to gather information about the presence of common symptoms such as sore throat, cough, fever, chills, feeling of fatigue, weight loss, etc. Additional factors to consider include pain in the enlarged lymph node, patient’s gender, age, occupation, sex life, presence of pets and information about medications taken. Fine-needle aspiration biopsy followed by cytological analysis or excisional biopsy (surgical biopsy) and histopathological studies can be performed to diagnose lymph node metastases in the neck region.
Treatment and course of the disease
Tuberculous lymphadenitis is usually treated with antituberculosis drugs. The duration of treatment depends on the sensitivity of the tubercle bacillus and the effectiveness of sterilization, and a full course of treatment for 6 months is usually recommended if lymph nodes are affected by pulmonary tuberculosis, including two TB medications. It is sometimes possible for tuberculosis to exacerbate due to the immune response, and most patients feel better after periodic courses of antituberculosis therapy. Drainage treatment, such as insertion of drainage tapes or aspiration of pus using a syringe pipette, may be used when a lymph node becomes soft and inflamed, accompanied by increased pain. Patients with symptoms of Kikuchi-Fujimoto’s disease are often prescribed antipyretics and anti-inflammatory analgesics for exacerbations. The site of the disease and the specifics of the patient’s condition are taken into account when prescribing treatment. In the case of reactive lymphadenitis, symptoms usually disappear within two weeks and no special treatment is required. If there is pain and discomfort in the lymph node, anti-inflammatory drugs may be used. Treatment of metastatic cervical cancer depends on the general condition of the patient, the duration of the disease and the time of the primary cancer that caused the metastases.
Additional radiotherapy is also performed and all surgical treatments for metastasizing lymph nodes, including primary foci, are excluded. This helps establish the presence of oral cancer, thyroid cancer or salivary gland tumour. In the case of stages where normal digestion is impaired, difficulty speaking and other dysphonia after treatment for pharyngeal cancer including tonsil cancer, laryngeal cancer and other types of cancer, surgery is usually resorted to early to minimise functional impairment after surgery and to reduce the size of the primary tumour. When patients are diagnosed with dysfunction or decide that postoperative radiotherapy is necessary, non-operative radiotherapy is often used as an alternative. However, there are also cases where postoperative radiotherapy is necessary, for example, if a preliminary diagnosis shows the presence of dysfunction or abnormalities.
