Lymph nodes are the policemen of our body. They are present all over but are not usually enlarged in size. Only in cases where the body requires protection, they show their presence. They then appear as enlarged entities which are seen at certain named sites.
These sites may be:
- Most commonly in the cervical region, in the neck
- Inguinal, in the groin
- Axillary, in the armpit
- Intra abdominal
The various causes of lymph node enlargement may be as follows:
The lymph nodes associated with an area of inflammation get enlarged as a response to that. This is reactive hyperplasia of the lymph nodes as a response. Once the primary inflammation subsides, this too will subside.
This may be Acute or Chronic.
In cases of acute lymphadenitis, the affected lymph nodes are enlarged and tender with some amount of redness. The patient may also have some constitutional symptoms in the form of fever, malaise, and loss of appetite. This is in response to infection in the part of the body that is drained by the lymph nodes. For example, in case of any oral cavity infection, tonsillitis or dental infection, the anterior cervical lymph nodes are enlarged. Similarly, if a patient has developed an infected wound in the leg or has cellulitis, the inguinal or groin lymph nodes of the corresponding side will be enlarged and tender.
In cases of chronic lymphadenitis, the swelling may be longstanding, gradually increasing and painless. In these conditions, we have to keep in mind the diagnosis of tuberculosis, lymphomas, HIV or metastasis from other cancers.
The various investigations that we conduct will help us reach the correct diagnosis.
Specific investigations are as follows:
CT Scan or a sonography of the area to see the exact size, site and number of enlarged nodes, quality of the node, whether it is solid inside or is showing any signs of liquefaction and any other associated abnormalities.
FNAC is a diagnostic pathological procedure whereby a needle is introduced into the enlarged lymph node under strictly sterile conditions and a specimen is extracted for cytology. This gives us a cytological diagnosis of the condition.
Sometimes, this report is equivocal and in such cases, a formal biopsy is required to be done under anesthesia to get the proper diagnosis. At times, it is found that the disease process has completely destroyed the normal structure of the interior of the lymph node and all that remains is a bag of pus. This pus is removed and sent for culture examination and the solid part of the node is sent for histopathology examination. After a formal biopsy, the specimen removed is sent for histopathology examination, culture and any special tests as the condition may demand. This is especially true if lymphomas are being suspected. In some cases, further imaging studies in the form of PET scans may be necessary.
It is very important to understand here, that removal of lymph nodes is NOT the end of the treatment. It just shows us the road forward and once we get our pathology and imaging reports and depending on these reports, we have to individualize the treatment.