Cervical Lymphadenopathy

Cervical Lymphadenopathy is a common presentation in the course of a number of diseases. The diseases can be neoplastic or inflammatory, and include lymphoma, metastatic carcinoma, granulomatous disease, toxoplasmosis, cat scratch disease, Kikuchi’s necrotizing lymphadenitis, dermatopathic lymphadenopathy, angioimmunoblastic lymphadenopathy. Few patients with inflammatory cervical lymphadenopathy are associated with a discharging cervical sinus, and these cases are mainly due to tuberculosis, actinomycosis and some other infections.

Cervical lymph nodes are also common sites of involvement in lymphoma. Lymphomatous nodes are usually difficult to differentiate from metastatic nodes in clinical examinations. Cervical Lymphadenopathy is a directly interior to the fibrous capsule is the subcapsular sinus. This allows lymph, an ultrafiltrate of blood, to traverse from the afferent lymph vessels, through the sinuses, and out the efferent vessels. The sinuses are studded with macrophages, which remove 99% of all delivered antigens. Metastases in cervical lymph nodes are common in head and neck cancers. The lymph node, with its high concentration of lymphocytes and antigen-presenting cells, is an ideal organ for receiving antigens that gain access through the skin or gastrointestinal tract. Nodes have considerable capacity for growth and change.

The presence of a metastatic node on one side of the neck reduces the 5-year survival rate of 50%, and the presence of a metastatic node on both sides of the neck reduces the survival rate to 25% [1]. Therefore, evaluation of cervical lymphadenopathy is important for patients with head and neck cancers as it helps the assessment of patient prognosis and the selection of treatment method. The disease can present at any age but is more prevalent in adolescents and young adults. The male to female ratio is 2:1. It usually presents as painless rubbery lymphadenopathy involving the superficial lymph node groups. The diagnosis is confirmed by lymph node biopsy.

Cause of Cervical Lymphadenopathy

The common causes of Cervical Lymphadenopathy follos:

• Bacterial infection of the upper extremities
• Lymphoma
• Upper respiratory tract infection
• Cat scratch disease
• Lyme disease
• Toxoplasmosis
• Metastasis
• Sarcoidosis
• Autoimmune
• Drug induced pseudolymphoma
• Storage disease: Generalized lymphadenopathy is an important manifestation of the lipid storage diseases. In Niemann-Pick disease, sphingomyelin and other lipids accumulate in the spleen, liver, lymph nodes, and central nervous system. In Gaucher disease, the accumulation of the glucosylceramide leads to the engorgement of the spleen, lymph nodes, and the bone marrow.
• Although widespread lymphadenopathy is observed commonly, additional findings, such as hepatosplenomegaly and developmental delay in Niemann-Pick disease and blood dyscrasias in Gaucher disease, usually are present. These diagnoses are established by leukocyte assay.
• Drug reactions: Adverse drug reactions can cause generalized lymphadenopathy.

Other causes are:

(1) Mycobacterial adenitis- atypical (MAIS complex), swollen, non-tender, nor-inflamed, positive skin test, excision is curative, chemotx is of no value.

(2) Cat-Scratch adenitis- caused by A. Fellis, transmitted by kittens, positive complement fixation test, minimally tender, fluctuant regional nodes, spontaneous resolution.

(3) Hodgkin's disease mostly teenager and young adults, continuing growth, non-tender node, associated to weight loss, biopsy is diagnostic.

Symptoms of Cervical Lymphadenopathy

Important clinical symptoms include the history of the infection, the length of such history, the presence or absence of systemic symptoms or a history of any chronic auto-immune or lipid storage condition. Tuberculosis contact, the presence of cats in the house as well as any viral or bacterial infections, Mycobacteria other than tuberculosis or any medical history worthy of note are suggestive of these aetiologies. Some common sypmtoms of Cervical Lymphadenopathy:

• Cherubism
• Diphtheria
• Hodgkin's lymphoma
• Kawasaki disease
• Kerion
• Kikuchi-Fujimoto disease
• Kimura's disease
• Ludwig angina
• Mycobacterium scrofulaceum
• Mycobacterium tuberculosis
• Nasopharyngeal carcinoma
• Oropharyngeal cancer
• Parotid cancer
• Thyroid carcinoma
• Tongue cancer
• Tonsillar cancer
• Tonsillitis
• Upper respiratory tract infection
• Vincent's angina

Treatment of Cervical Lymphadenopathy

The main treatment of Cervical Lymphadenopathy:

• Most clinicians treat children with cervical lymphadenopathy conservatively. Antibiotics should be given only if a bacterial infection is suspected. This treatment is often given before biopsy or aspiration is performed. This practice may result in unnecessary prescription of antimicrobials. However, the risks of surgery often outweigh the potential benefits of a brief course of antibiotics.
• Surgical care usually involves a biopsy. If lymphadenitis is present, aspirate may be needed for culture, and removal of the affected node may be indicated.

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