The Adenomegaly Is the palpable enlargement of the lymph nodes. Most of the time it responds to benign processes, but they should be examined closely because they can be a manifestation of a serious illness.
Lymph nodes are present throughout the body, but the major agglomerations occur in the neck, armpits and inguinal region. Some small nodules (
Lymph nodes, along with spleen, tonsils, adenoids and Peyer patches, are highly organized centers of immune cells that filter the antigen from the extracellular fluid.
Directly inside the fibrous capsule is the subcapsular sinus. This allows the lymph, an ultrafiltrate of blood, to pass through the afferent lymphatic vessels through the sinuses and efferent vessels. The paranasal sinuses are full of macrophages, which remove 99% of all antigens administered.
Inside the subcapsular sinus is the cortex, which contains primary follicles, secondary follicles and the interfollicular zone. Follicles within the cortex are important sites for B cell proliferation, while the interfollicular zone is the site of differentiation and proliferation of antigen-dependent T cells.
The deepest structure within the lymph node is the cord, which consists of plasma cell strings and small B lymphocytes that facilitate the secretion of immunoglobulin into the exiting lymph.
The lymph node, with its high concentration of lymphocytes and antigen-containing cells, is an ideal organ to receive antigens that have access through the skin or the gastrointestinal tract.
Nodes have a considerable capacity for growth and change. The size of the lymph node depends on the person's age, location of the lymph node in the body, and history of immunological events.
In neonates, lymph nodes are barely perceptible, but a progressive increase in the total mass of lymph nodes is observed until late childhood. Lymph node atrophy begins during adolescence and continues through later life.
Pathophysiology of adenomegaly
Some cells and plasma (eg cancer cells, infectious microorganisms) in the interstitial space, along with certain cellular material, antigens and foreign particles enter the lymphatic vessels, becoming lymphatic fluid.
Lymph nodes filter the lymphatic fluid on its way to the central venous circulation, eliminating cells and other materials. The filtering process also presents antigens to the lymphocytes contained within the nodes.
The immune response of these lymphocytes involves cell proliferation, which can cause the lymph nodes to enlarge.
Pathogenic microorganisms transported in the lymphatic fluid can directly infect the lymph nodes, causing lymphadenitis, and cancer cells can lodge and proliferate in the lymph nodes.
Etiology
Because lymph nodes participate in the body's immune response, a large number of infectious and inflammatory disorders and cancers are potential causes. The most likely causes vary depending on the patient's age, associated findings, and risk factors, but in general the most common causes are:
- Idiopathic, self-limited.
- Upper respiratory infections (URI).
- Local soft tissue infections.
Adenomegaly is detected during the evaluation of other types of diseases or ailments. Reviewing systems should look for symptoms of possible causes, including:
- Congested nose.
- Sore throat (pharyngitis, mononucleosis).
- Gum or toothache (oral-dental infection).
- Cough or dyspnoea (sarcoidosis, lung cancer, some fungal infections).
- Fever, fatigue and discomfort (mononucleosis and many other infections, cancers and connective tissue disorders).
- Genital lesions or secretions (herpes simplex, chlamydia, syphilis).
- Pain in the joints and / or swelling (or other connective tissue disorders).
- Easy bleeding and / or bruising (leukemia).
- Dry, irritated eyes (Sjögren's syndrome).
To do this, it is necessary to take certain precautions to determine the possibility of suffering some pathology, including:
- Vital signs of fever should be checked.
- Areas of particular concentration of lymph nodes in the neck (including Occipital areas And supraclavicular), the armpits and the inguinal region.
- The size and consistency of the node is observed, as well as if the nodes are freely movable or attached to the adjacent tissue.
- The skin is inspected for rashes and injuries, paying special attention to areas drained by affected nodes.
- The oropharynx should be inspected and palpated for signs of infection and any lesions that may be cancerous.
- The thyroid gland should also be palpated for enlargement and nodularity.
- Breasts (including men) should be felt for lumps.
- The lungs should be auscultated to crackle (suggesting sarcoidosis or infection).
- The abdomen is palpable due to hepatomegaly and splenomegaly. The genitals are examined for chancres, vesicles and other lesions, and for urethral discharge.
- The joints are examined for signs of inflammation.
Alerts that may indicate adenomegaly:
- Ganglia greater than 2 cm.
- Ganglia that is draining, that is hard or fixed to the underlying tissue.
- Supraclavicular ganglion.
- Risk factors for HIV or tuberculosis.
- Fever and / or weight loss.
- Splenomegaly.
Interpretation of findings
Patients with generalized lymphadenopathy usually have a systemic disorder, whereas patients with localized lymphadenopathy may have a local or systemic disorder (including one that often causes generalized adenomegaly).
Sometimes, history and physical examination suggest a cause and may be diagnosed in patients with local soft tissue or dental infection.
In other cases, the findings do not point to a single cause. Nodules that are hard, markedly enlarged (> 2 to 2.5 cm), and / or attached to adjacent tissue, particularly nodules in the supraclavicular area or in patients who have had prolonged use of tobacco and / or alcohol, may be indicators Of cancer.
Sensitivity, erythema and heat marked in a single enlarged nodule may be due to a suppurative node infection. Fever can occur with many of the infectious, malignant and connective tissue disorders. Splenomegaly can occur with mononucleosis, toxoplasmosis, leukemia and lymphoma. Weight loss occurs with tuberculosis and cancer.
Tests
Further evaluations depend on the lymph nodes involved and the other findings present. Patients with findings of adenomegaly alerts and those with adenomegaly should have a BCC and chest X-ray.
If abnormal white blood cells are seen in the BCC, a peripheral smear and flow cytometry are performed to evaluate leukemia or lymphoma.
Most clinicians also usually perform a tuberculin test (or an interferon-gamma release assay) and serological tests for HIV, mononucleosis and perhaps toxoplasmosis and syphilis.
Patients with joint symptoms or rash should be tested for antinuclear antibodies.
Most physicians believe that patients with localized adenomegaly and no other findings can be safely observed for 3 to 4 weeks, unless cancer is suspected.
In that case, patients should usually have a lymph node biopsy (patients with cervical mass require a more extensive evaluation before the biopsy).
Submandibular adenomegaly or Kimura's disease
Kimura disease is a rare chronic inflammatory disease of unknown etiology, more common in young Asian adult men.c It presents as a painless subcutaneous mass in the head or neck, blood and tissue eosinophilia and elevation of serum IgE.
Histological examination usually involves a lymph node with follicular hyperplasia, vascular proliferation, endothelial hyperplasia of the post capillary venules, and pronounced infiltration of eosinophils.
Kimura's disease can mimic a neoplasm. Although rare, it should be taken into account in the differential diagnosis of a cervical lymph node with eosinophil infiltration and prominent follicular hyperplasia.
References
- (N.d.) Farlex Partner Medical Dictionary. (2012). Retrieved February 11 2017 from medical-dictionary.thefreedictionary.com.
- . Submandibular adenomegaly or Kimura's disease. 11-2-2017, from Excellence in Pediatrics Website: ineip.org.
- Kanwar, V. (2016). Lymphadenopathy. 11-2-2017, MedScape Website: emedicine.medscape.com.
- Douketis, J. (2015). Lymphadenopathy. 11-2-2017, University; Joseph's Hospital Website: merckmanuals.com.
- Hernández, M.A. (2011). Ganglia. Lymphadenopathy: importance and consequences. 11-2-2017, of familiaysalud.es.
- Page 2 The patient with adenomegaly. 11-2-2017, of Panamerican Medical Publishing House.