Enlarged lymph nodes
"Lymphadenopathy" means the swelling of the lymph nodes; it presents with an abnormal and uncontrolled enlargement of the same: the lymphadenopathy could be due to an invasion of foreign cells, to an alteration of the synthesis mechanisms of the constituent cells or to the hyperproduction of reticulo-endothelial cells.
Physiological lymphadenopathy
Lymphadenopathy, however, does not necessarily represent an alarm bell: in fact, in infants there is often a physiological increase in the size of the lymph nodes, just as a mild inguinal lymphadenopathy in the adult must not be alarming. Again, the lymphadenopathic process is considered normal for those people who perform manual work: in the latter case, the enlargement of the size of the lymph nodes is recorded, more often than not, at the inguinal and axillary level.
The physiological increase in the volume of the lymph nodes generally occurs in infancy and regresses slowly and spontaneously in the adult.
Where it occurs
In general, lymphadenopathy occurs in the neck, armpits, groin, chest and near the clavicles. If the swelling of a lymph node were caused by the infection of the lymphatic canal, we speak of lymphangitis (or lymphatic disease); the term lymphadenomegaly indicates, instead, that condition in which the lymph nodes exceed the 2 cm of diameter (rarely benign event).
Lymphadenopathy could remain confined to a given area, or extend into various areas of the body.
Pathological or benign lymphadenopathy?
If the condition is no longer considered to be physiological but rather potatological, lymphadenopathy could occur in conjunction with: inflammatory processes, lymphomas, viral or bacterial infections, alteration of endocrine production, neoplasms or connective tissue diseases.
To clarify: there is a limit between the "benign" (ie physiological) lymphadenopathic manifestation and its dangerous (pathological) form. This limit is represented by the symptomatology that the affected subject presents. Lymphadenopathy does not cause damage if the condition does not invade the fat or capsule if the myotic action remains localized at the level of the germinative center, and if the disease is located in the cortical area with a disorganized division of the follicles. The benign forms generally affect the mediastinal areas. Otherwise, lymphadenopathy assumes a malignant connotation, particularly dangerous and more frequent in subjects suffering from AIDS or immunosuppressive diseases in general, sarcoidosis (autoimmune diseases), tuberculosis and leukemia. Non-Hodgkin's lymphomas (eg mycosis fungoides and Sèzary's syndrome) and Hodgkin's lymphomas are often related to lymphadenopathy conditions.
The problem is the distinction of the two forms of lymphadenopathy (benign or pathological): in fact, even a computerized diagnosis of lymphoma, in most cases, gives uncertain results because the analytical frameworks that highlight the density and cellular morphology of lymphatic interest they are very similar in both benign and malignant forms.
Classification
The lymphadenopathies can also manifest themselves as the primary symptom of a pathology, or they can be the consequence; for this reason, neoplastic lymphadenopathies are classified into:
- Primary malignant neoplastic lymphadenopathy: typical manifestation of Hodgkin's and non-Hodgkin's lymphomas
- Secondary neoplastic lymphadenopathy: in particular, they originate following cancers of the colon, pancreas, kidneys, urinary tract and pancreas.
Causes
The etiopathological picture presents many factors that contribute to the formation of lymphadenopathy: if the condition is circumscribed, therefore localized in a given area, usually the cause is traced back to an inflammatory state, a trauma or an infection.
If the condition is generalized (involving more lymph nodes "swollen" in various areas of the body), lymphadenopathy could be an indicator of AIDS, metastases determined by carcinomas or advanced lymphomas, or infections that lead for example to tuberculosis, brucellosis, mononucleosis, toxoplasmosis .
Diagnosis
The techniques that can determine whether or not the lymphadenopathy are:
- lymphography: technique with high specificity and sensitivity, which detects dimensional and structural changes in lymphocytes in vivo. It is not, however, precise because of the difficulty of the investigation (many cases of false negatives have been recorded), since the outcome could be erroneous: in this regard, the lymphography is used only as a complementary diagnosis, not preferential.
- Computed tomography: diagnostic imaging therapy that uses X-rays and provides 3D images of the areas analyzed.
- Magnetic resonance: it presents problems of poor specificity
It is therefore absolutely essential that the patient with evident swelling at the level of the lymph nodes contact his doctor to ascertain the absence of serious pathologies; even if lymphadenopathy, in many cases, is a sign of harmless manifestations, it should certainly not be underestimated.
