Lymphadenopathy

Causes

(1) Reactive lymphadenitis

• Hyperplasia of B cells, T cells, or histiocytes

(2) Infiltrative disease

• Examples—metastasis (most common) and malignant
lymphoma
 Painful lymph nodes

Localized painful lymphadenopathy

• Seen in localized infection (e.g., tonsillitis).

• Most common sites are the anterior cervical nodes (e.g.,
tonsillitis) and the inguinal nodes (e.g., lymphogranuloma
venereum, chancroid).

Generalized painful lymphadenopathy

• Primarily seen in systemic disease
• Examples—infectious mononucleosis, SLE
 Painless lymphnodes
- Suggestive of malignancy
- Lymph nodes usually indurated and often fixed to the surrounding tissue
Localized painless lymphadenopathy
- Metastatic
• Examples—axillary lymph nodes in breast cancer and inguinal lymph nodes
in vulvar squamous cell carcinoma
- Hodgkin lymphoma (HL) and other types of malignant
lymphoma
Generalized painless lymphadenopathy
- Occurs in the majority of acute and chronic leukemias except hairy cell
leukemia
- Occurs in follicular B-cell lymphoma and other types of malignant
lymphoma
 Lymph node groups involved in primary or
metastatic cancer

(1) Submental lymph nodes

• Metastatic squamous cell carcinoma in the floor of the mouth

(2) Cervical lymph nodes

(a) Metastatic head and neck tumors (e.g., larynx; thyroid,
nasopharynx)
(b) Hodgkin lymphoma

(3) Left supraclavicular lymph nodes (Virchow nodes)

• Metastatic abdominal cancers (e.g., stomach; pancreas)
 Lymph node groups involved in primary or
metastatic cancer

(4) Right supraclavicular lymph nodes

(a) Metastatic lung and esophageal cancers
(b) Hodgkin lymphoma
(5) Axillary lymph nodes
• Metastatic breast cancer
(6) Epitrochlear lymph nodes
• Non-Hodgkin lymphoma
(7) Hilar lymph nodes
• Metastatic lung cancer
 Lymph node groups involved in primary or
metastatic cancer

Mediastinal lymph nodes

(a) Metastatic lung cancer
(b) Hodgkin lymphoma (particularly the nodular sclerosing type)
(c) T-cell lymphoblastic lymphoma

(9) Tonsillar (superior jugular node)

• Metastatic squamous cancers in the oral cavity
 Lymph node groups involved in primary or
metastatic cancer

Mediastinal lymph nodes

(a) Metastatic lung cancer
(b) Hodgkin lymphoma (particularly the nodular sclerosing type)
(c) T-cell lymphoblastic lymphoma

(9) Tonsillar (superior jugular node)

• Metastatic squamous cancers in the oral cavity
 Lymph node groups involved in primary or
metastatic cancer

(10) Pre-aortic lymph nodes

(a) Metastatic testicular cancer
• Testicles migrate to the scrotum from the abdomen.
(b) Burkitt lymphoma

(11) Inguinal lymph nodes

• Metastatic vulvar and penis squamous cancers
 Types of reactive lymphadenitis

Follicular hyperplasia.
-B-cell antigenic response
b. Examples
(1) Early stages of HIV infection
(2) Other examples—rheumatoid arthritis and SLE

Paracortical hyperplasia
T-cell antigenic response
Dermatopathic lymphadenitis
Other examples—phenytoin and viral infections
Mixed B- and T-cell hyperplasia
a. Cat-scratch disease
b. Toxoplasmosis
c. Tularemia
 Types of reactive lymphadenitis

Sinus histiocytosis
• Benign histiocytic response in lymph nodes draining a tumor