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1. What is lymphadenopathy?

It is an enlargement of the lymph nodes that is either detected by the patient or the doctor during a clinical examination.

2. What causes it?

A wide range of diseases involving different medical specialties may include lymphadenopathy.

Main causes of lymphadenopathy

A) Infectious

Viral: Epstein Barr Virus (Infectious Mononucleosis), cytomegalovirus, herpesviruses, adenoviruses, HIV infection and many others.

Bacterial & parasitic infections: Brucellosis, staphylococcus, streptococcus, tuberculosis, atypical mycobacteria, salmonellosis, toxoplasmosis, etc.

B) Autoimmune diseases

Rheumatoid arthritis, systemic lupus erythematosus, Sjögren’s syndrome, sarcoidosis, etc.

C) Serum sickness reactions

To drugs and other substances.

D) Malignant diseases

Hodgkin & non-Hodgkin lymphoma, chronic lymphocytic leukemia, acute lymphoblastic and acute myeloid leukemia and metastases of solid tumors.

E) Rarer diseases

We mention, for example, histiocytosis X, Gaucher disease, Kawasaki syndrome, Nieman Pick, etc.

3. How is the diagnosis made?

It is very important to take a good history and a clinical examination. The age, the location of the swollen lymph nodes, their texture, i.e. whether they are soft or hard, their size, whether they are painless or painful and the symptoms that the patient exhibits are very important elements for diagnosing the cause of lymphadenopathy.

The diagnosis includes laboratory testing (e.g. complete blood count, TCE, CRP, biochemical testing, detection of antibodies against viruses, testing for rheumatological diseases, etc.) and imaging testing depending on the case (such as chest X-ray, CT scans).

Lymph node biopsy is a serious additional diagnostic element but the decision is made by the specialist doctor after evaluating all the clinical and laboratory findings and the patient’s history. It is performed by a surgeon and the material must be evaluated by an experienced hematopathologist.

When a complete examination is performed that includes a lymph node biopsy and no specific cause is found, then the lymphadenopathy is classified as non-specific. Non-specific lymphadenopathy can be up to 50% of cases.

Finally, it should be emphasized that taking a very good history, clinical examination, age, gender, habits, lifestyle and occupation may be associated with the type of lymphadenopathy. The doctor evaluates the patient’s symptoms and directs diagnostically. The type of fever, if present, the presence of the so-called B symptoms (fever without a focus of infection, unexplained weight loss >10% in six months, night sweats), may be accompanying evidence of lymphoma. The presence of itching or rash may also be important for the diagnosis.

Often, collaboration between doctors from different specialties is needed, such as an otolaryngologist, a pulmonologist, an infectious disease specialist, a dentist, etc.

4. What is the most common location of lymphadenopathy?

The location can be in many different parts of the body, but statistically the most common is in the neck area.

Conclusion

Once a specific diagnosis is made with lymph node biopsy, the appropriate therapeutic strategy is followed.

The group of patients in whom lymph node biopsy is not required should be monitored until complete resolution of lymphadenopathy.