Dr. Peyman Eshghi; Pediatric Hematology and Oncology
Pathological enlargement of the lymph nodes
Lymphadenopathy or pathological enlargement of the lymph nodes is one of the important symptoms with a wide diagnostic range in medicine, which therefore poses major diagnostic challenges, especially in children. By definition, an increase in the number and size of lymph nodes, a change in the consistency of lymph nodes, or the appearance of new lymph nodes in sites that did not already exist is called lymphadenopathy or lymph node disease, but based on the size, location and consistency of lymph nodes, symptoms Accompanying clinical, age, and history can identify cases that need further investigation and follow-up and clinical supervision. Three types of classifications for lymphadenopathies have been reported in scientific literature. Pathological classification; Pathophysiological; And place. The most common classification of lymphadenopathies is based on their location. In this type of classification, lymphadenopathies are divided into two categories: generalized (involvement ≤ 2 adjacent groups) and localized (involvement of a group of lymph nodes that have similar drainage). Generalized lymphadenopathy is a sign of a systemic disease. Knowing the map in the lymphatic system is very important in recognizing local lymphadenopathies.
Causes other than lymphadenopathy should always be considered, especially in masses of the head, neck, and mediastinum. If the examination, size, consistency, cirrhosis, accompanying symptoms, and especially the location of the lymph node are suspected of malignancy, a biopsy should be performed at the earliest opportunity, especially if other less invasive tests (including bone marrow aspiration) fail. The following are helpful in diagnosing pathological lymphadenopathy (cases that require further investigation, follow-up, and clinical monitoring):
Lymph nodes <0.5 cm are not usually seen in infancy and early infancy.
In the age range of children (from 2 to 8 to 12 years old), the lymph nodes of the anterior neck chain up to 2 cm in size, axillary cm 1, and inguinal 1.5 cm are considered normal.
In children, lymph nodes larger than 3 cm are usually malignant.
The presence of any supraclavicular or epitrocholic lymph nodes (even with a size> 0.5 cm) are usually due to malignancies.
Although benign glands can be stiff, they are usually malignant, with irregular, non-thorny, sticky surfaces attached to adjacent tissues.
Painful glands, along with inflammation and heat, are usually caused by a direct infection of the lymph nodes or lymphadenitis, and sometimes develop a condensate in the abscess.
Generalized lymphadenopathy is the enlargement of 2 groups of adjacent lymphatic chains and is a sign of a systemic disease. The involvement of a lymphatic chain group with splenomegaly will mean the same thing.
No complaints or signs of inflammation or associated local infection (including sore throat, skin ulcer, dermatitis); Lymph node does not shrink to normal within 4 to 6 weeks or enlarges within 2 weeks despite treatment of local infection and inflammation; And the presence of systemic symptoms (such as fever for more than a week, weight loss, Sweating And bone pain) is a sign of lymphadenopathy with a major systemic pathology.
How and under what conditions do we perform lymph node biopsy?
Biopsy should be performed at the earliest opportunity, especially if other less invasive tests (including Bone marrow aspiration) Does not result.
the door biopsy The right gland must be selected. For example, in the neck, the lower anterior to upper anterior chains are preferred. Axillary is also preferred over anterior chain.
The largest or hardest gland should be biopsied, even if it is less available. The lymph node should be completely encapsulated, not dried, left in the heat and in the light.
Excisional complete biopsy is the ideal procedure. Aspiration and needle biopsy, especially in children, do not provide a sufficient sample. Therefore, it is used only in cases of suspected infection or involvement of sarcomatosis in glands with difficult access.
Preparation of Imprint or Touch prep on glass slide Whenever malignancy is suspected, it is necessary for morphological evaluation of cells and faster diagnostic and treatment planning (Table 5).
The appearance of reactive hyperplasia or nonspecific granuloma does not rule out lymphoma, especially Hodgkin’s disease, so it is not surprising that the first biopsy of a Hodgkin’s patient was reported to be normal. Therefore, additional diagnostic measures have been proposed on tissue samples with suspected clinical baseline and various aspiration smears.
Read more: What is lymphadenopathy?