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LIMFADENOPATI

LIMFADENOPATI. IRZA WAHID SUBAGIAN HEMATOLOGI & ONKOLOGI MEDIK FK UNAND / RS DR M DJAMIL PADANG. Definition. Lymph nodes that are abnormal in size, consistency or number  Generalized involvement of 3 or more noncontiguous lymph node areas.  Localized. Non Burkitt’s.

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LIMFADENOPATI

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

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

  3. Non Burkitt’s Lymphoid generation Lymphocyte Lymphoplasmocytoid Plasma cell * AG INDEPENDENT DIFFRERENTIATION * STEM CELL / THYMUS * AG DEPENDENT DIFFRERENTIATION * NNLL, MALT

  4. 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.

  5. Lymphatic System • Network that filters antigens from the interstitial fluid • Primary site of immune response from tissue antigens • Lymphatic drainage in all organs of the body except brain, eyes, marrow and cartilage • 600 lymph nodes in body • Slow flow, low pressure system returns interstitial fluid to the blood system

  6. Jar. LimfoidPerifer Nnlldan Malt

  7. 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, atravel history. • Physical examination • Laboratoric test • Imaging studies to determine the extent and character of the lymphadenopathy • Histopatologic examination

  8. 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.“

  9. 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.

  10. Lymph node character • Site • Size • Consistency • Pain with palpation

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

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

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

  14. Site

  15. Post cervical: scalp, neck skin of arms thorax cervical and axillary nodes (lymphoma, head/neck ca)

  16. M I A M I MALIGNANT  lymphoma, metastatic INFECTION  acute, chronic AUTOIMMUNE DISEASE MISCELANOUS DISEASE  UNNUSUAL IATROGENIC

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

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

  19. Bacterial • Staph/strep: cutaneous source, lymphadenitis • Cat scratch: bartonellahensalae, two weeks after inoculation • Mycobacterium: TB and non-tb, host characteristics

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

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

  22. TERAPHYETIOLOGY

  23. T H A N K Y O U

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