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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 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 Lymphoid generation Lymphocyte Lymphoplasmocytoid Plasma cell * AG INDEPENDENT DIFFRERENTIATION * STEM CELL / THYMUS * AG DEPENDENT DIFFRERENTIATION * NNLL, MALT
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 • 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
Jar. LimfoidPerifer Nnlldan Malt
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
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 • Size • Consistency • Pain with palpation
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
Pain….. • Indication of rapid increase in size: stretch of capsular shell • NOT useful in determining benign vs malignant state • Inflammation, suppuration, hemorrhage
Consistency • Stone hard: typical of cancer usually metastatic • Firm rubbery: can suggest lymphoma • Soft: infection or inflammation • Suppurated nodes: fluctuant • Matting
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: 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
I N F E C T I O N • Bacterial • Viral • Protozoan • Mycotic • Rickettsial (typhus) • Helminthic (filariasis)
Bacterial • Staph/strep: cutaneous source, lymphadenitis • Cat scratch: bartonellahensalae, two weeks after inoculation • Mycobacterium: TB and non-tb, host characteristics
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
Protozoan • Toxoplasmosis: ELISA assay, intracellular protozoan toxoplasmosis gondii….bilateral, symmetrical, non-tender cervical adenopathy …consider undercooked meat, reactivation in immuncompromised host