LIMFADENOPATI

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

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

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Lymphoid generation
Lymphocyte Lymphoplasmocytoid Plasma cell
AG INDEPENDENT DIFFRERENTIATION STEM CELL /
THYMUS
AG DEPENDENT DIFFRERENTIATION NNLL, MALT
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• 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.

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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

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Jar. Limfoid Perifer Nnll dan Malt
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• 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

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• 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.

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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.
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Lymph node character

• Site
• Size
• Consistency
• Pain with palpation

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Size

• Greater than one centimeter generally considered
  abnormal
• Exception inguinal area, lymph nodes commonly
  palpated (gt1.5 cm)
• Size does not indicate a specific disease process
• Obese and thin population

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Pain..

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

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Consistency

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

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Site
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• Post cervical scalp, neck skin of arms thorax
  cervical and axillary nodes (lymphoma, head/neck
  ca)

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• M I A M I
• MALIGNANT ? lymphoma, metastatic
• INFECTION ? acute, chronic
• AUTOIMMUNE DISEASE
• MISCELANOUS DISEASE ? UNNUSUAL
• IATROGENIC

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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

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I N F E C T I O N

• Bacterial
• Viral
• Protozoan
• Mycotic
• Rickettsial (typhus)
• Helminthic (filariasis)

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Bacterial

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

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VIRAL

• EBVmono spot test
• CMV.cmv titers, immunsuppresed, transplant
  recipient, recent blood transfusion
• HIVIV drug use, high risk sexual behavior
• Hepatitis.IV drug use
• Herpes Zoster.superficial cutaneous nodules

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Protozoan

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

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TERAPHYETIOLOGY
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T H A N K Y O U