I. Infectious lymph node enlargement
(A) Non-specific lymphadenitis
The enlarged lymph nodes in the corresponding drainage area caused by acute and chronic infection of local tissues are called non-specific lymphadenitis. The lymph nodes are often treated with fever and increased white blood cells and can often be reduced in size. Chronic non-specific lymphadenitis is often the result of chronic inflammation in the corresponding area.
Acute nonspecific lymphadenitis is characterized by the coexistence of local infection and enlargement of lymph nodes in the corresponding area, such as acute infection of the facial features or head often causes enlargement of lymph nodes in the neck under the jaw, behind the ear, behind the occiput, etc.; acute infection of the chest wall of the upper trunk breast causes enlargement of lymph nodes in the axilla; infection of the lower extremities and perineum causes enlargement of lymph nodes in the groin Chronic nonspecific lymphadenitis is most commonly seen in the submandibular lymph nodes Those with past nasopharyngeal or oral infections followed by inguinal lymph nodes caused by chronic inflammation of the lower extremities and genital organs.
(B) Atopic infectious lymph node enlargement
1. Lymph node tuberculosis
There are two types of primary and secondary lymph node tuberculosis: primary lymph node tuberculosis without other primary tuberculosis lesions can be found, and secondary lymph node tuberculosis is secondary lymph node tuberculosis when it appears after lesions in the chest, lungs, abdomen or genitalia. The swelling is hard and painless, and further development of lymph nodes and skin and lymph node adhesions fuse into a mass that is not easy to move, and in the late stage, caseous necrosis liquefies to form a cold abscess and then breaks down to form a chronic ulcerated thin tube that leaves a scar after healing.
2. Filarial lymphangitis and lymphadenitis
Infection with filarial parasites such as Filaria zoster and Filaria marcescens can cause chronic lymphangitis and lymphadenitis, with clinical symptoms varying according to the location of the lesion, most commonly in the inguinal lymph nodes, and if the lower limb lymphatic drainage is obstructed, it can cause rubbery swelling of the lower limbs.
3. STD lymph node enlargement
(1) Soft chancre: painful genital ulcers covered with green necrotic exudate caused by Streptococcus pyogenes (Streptococcus soft chancre), and swollen inguinal lymph nodes on one or both sides.
(2) Lymphogranuloma venereum: caused by Chlamydia trachomatis L1L2 and L3 serotypes, the main lesions are in the lymphatic tissues, initially in the external genitalia, anus, rectum, etc. Painless papules or ulcers may appear after a few days.
(3) inguinal granuloma: painless granulomatous ulcers of the genitalia and nearby areas caused by Mycobacterium dono-vania, identified mainly by tissue smears to find (Dono-vania) vesicles
(4) Syphilitic lymph node enlargement: symmetrical inguinal lymph node enlargement often occurs about 1 week after the appearance of hard chancre on the external genitalia about 3 weeks after infection with syphilis, and is hard, not red, not painful, not fused and not adherent.
(5) AIDS (AlDS) lymph node enlargement: prone to fatal condition infections such as Pneumocystis carinii pneumonia can be complicated by tumors such as Kaposi’s sarcoma during the course of the disease some people develop chronic lymph node syndrome manifested as generalized lymph node enlargement with inguinal lymph node enlargement being the most obvious diagnosis mainly relies on medical history and serological examination
4Snake venomous lymphadenitis The bite of a venomous snake often causes inflammation of the lymph vessels and lymph nodes in the corresponding area in addition to local symptoms.
(C) Lymph node enlargement caused by systemic infection
Many systemic infectious diseases can cause lymph node enlargement in a wide range of pain or pressure pain may not be obvious, often accompanied by fever, hepatosplenomegaly, etc. The common ones are as follows
1. Infectious mononucleosis
Caused by EBV mostly seen in adolescents with a self-limiting course usually 1 to 2 weeks mainly manifested as irregular fever pharyngitis lymph nodes hepatosplenomegaly lymphocytosis in the blood and the presence of abnormal lymphocytes positive serum heterophilic agglutination test
2.Rubella
Rubella virus causes a common respiratory infection most often seen in children with swollen lymph nodes and rash at the same time has diagnostic significance after 1 to 2 fever rash rapidly spreads over the trunk and extremities palms and soles of the feet often without rash swollen lymph nodes most commonly behind the ear under the occipital bone back of the neck is its characteristic rash usually lasts 3 d and then subsides swollen lymph nodes often take several weeks to fully recover
3. Measles
Most commonly seen in children initially with fever and upper respiratory tract khat symptoms measles membrane spots (Koplik spots) for the early features of the disease fever 3 to 5 d rash on the palms and soles of the hands and feet also have rash rash when the rash can be swollen lymph nodes liver tiles throughout the body
4.Cat scratch disease
Acute infectious disease caused mainly by cat scratching was previously thought to be a virus and is now more likely to be caused by a small polymorphic gram-negative bacillus scratched skin can be seen as herpes pustules crust or small ulcer formation can have weeks of slight fever scratching 1-2 weeks after the corresponding drainage area lymph nodes swollen with pressure pain some lymph nodes can be pus specific antigen intradermal test positive pus bacterial culture negative saturated silver stain found polymorphic gram-negative small bacilli
5. Tsutsugamushi disease
The bite of scrub typhus mite larvae appears as a papular rash with water sores and then ruptures with a central necrotic brown scab called a scorch.
6.Brucellosis
There is a long-term fever mostly flaccid fever partly wavy type most specific multiple joint soreness orchitis sweating more history of contact with sick cattle and sheep serum agglutination test helps to diagnose
7.Glandular plague
Swollen lymph nodes are the first lesions to appear during an epidemic inguinal lymph nodes are the first to be involved followed by axillary cervical lymph nodes often with heavy systemic symptoms swollen and painful lymph nodes can be softened and septicized pus is found in the pus to confirm the diagnosis of plague bacillus
8. Scarlet fever
Swollen lymph nodes mostly in the neck and submandibular body skin scarlet rash and flaking after fading strawberry tongue pharyngitis pharyngeal swab culture often has the growth of group B group A streptococcus
9.Leptospirosis
often have foot and intestinal muscle pain and pressure pain hemoptysis gangrene local lymph node enlargement accounted for 20% of the whole body lymph node enlargement 15% of the most common inguinal lymph nodes followed by axillary lymph nodes Leptospira agglutination lysis test more than 1:400 potency is positive with high specificity and sensitivity
10.Rat bite fever
Acute infectious disease caused by rodent bites with small spirochetes as the etiologic agent, with high fever, local hard nodular ulcers, local lymph node enlargement, pressure pain, rash, etc.
11.Toxoplasmosis
The end hosts are cats and felines, birds, mammals and human intermediate hosts. In humans, infection is associated with swallowing undercooked meat or drinking water contaminated with oocysts. examination
12. Rabbit fever
It is an acute infectious disease caused by Bacillus tularensis with fever, skin ulcers, localized lymph nodes, respiratory symptoms, conjunctival congestion, etc. History of contact with rabbits or insect bites to confirm the diagnosis depends on bacterial isolation and positive immune response.
13. Black fever
Patients with hyperthermia liver and spleen lymph node enlargement anemia leukopenia leishmania can be found in the bone marrow
II. Neoplastic enlargement
1.Leukemia
Leukemia often has enlarged lymph nodes, but the degree of enlargement does not distinguish between the various types of leukemia. Generally speaking, lymph node enlargement is more obvious in acute or chronic lymphocytic leukemia. Acute non-lymphocytic leukemia and chronic granulocytic leukemia may also have enlarged lymph nodes. However, the number of sites is not as extensive and obvious as in lymphocytic leukemia. Chronic granulocytic leukemia can be distinguished by the characteristics of cell types and primitive cells in the blood and bone marrow and by cytochemical staining. The lymph nodes of the latter may be enlarged and adhere to form a mass, which is hard but not painful, and the hepatosplenomegaly is often obvious.
2.Malignant lymphoma
Hodgkin’s disease and non-Hodgkin’s lymphoma are divided into two categories. Both are characterized by chronic progressive painless lymph node enlargement, which is easily detected early in the supraclavicular fossa of the neck or axilla; those in the chest and abdomen are not easily detected early before symptoms of pressure appear. The swollen lymph nodes are soft and mobile in the early stage without pressure pain, and when they increase rapidly, they are hard and can have light pressure pain. Sometimes the swollen lymph nodes can temporarily shrink on their own and are easily misdiagnosed as lymphadenitis. Reed-sternberg (R-S) cells (microscopic cells); non-Hodgkin’s lymphoma shows a single form of tumor cells or lymphoid tissue cells without R-S cells; advanced lymphoma can invade the bone marrow at this time and lymphocytic leukemia is difficult to distinguish.
3.Plasmacytoma
(1) Multiple myeloma: a malignant tumor with abnormal proliferation of plasma cells, mostly seen in middle-aged and elderly people over 40 years old, mainly manifests as bone pain, pathological fracture, anemia, and immunoglobulin abnormalities.
① bone with osteolytic damage;
② abnormal plasma cells (myeloma cells) infiltration in the bone marrow is greater than 10%;
(3) The presence of large amounts of M protein in the blood or urine in multiple myeloma. There is often extramedullary infiltration and cause lymph node enlargement myeloma in advanced stage can appear in large numbers in the blood myeloma cells often > 20% absolute value > 2.0×109/L is called plasma cell leukemia.
(2) Primary macroglobulinemia: a malignant proliferative disease of plasma cell-like lymphocytes that secrete large amounts of IgM. The age of onset is more than 50 years old and the clinical manifestations are anemia, bleeding, enlargement of liver and spleen lymph nodes and neurological symptoms due to increased blood viscosity, visual impairment, Raynaud’s phenomenon, vascular embolism symptoms, etc. Serum electrophoresis appears as M component immunoelectrophoresis confirms monoclonal IgG in the bone marrow. Lymphocyte infiltration can confirm the diagnosis
(3) heavy chain disease: a class of plasma cells or abnormal lymphocytes malignant proliferation and produce a large number of monoclonal heavy chain and heavy chain fragments of the disease onset of more than 40 years old clinical manifestations vary, but most have lymph node enlargement persistent proteinuria without bone damage signs diagnosis is mainly based on serum immunoelectrophoresis and related physicochemical characteristics
4.histiocytosis
(1) Malignant histiocytosis (malignant group): often manifested as hyperthermia, anemia, hemorrhage, lymph nodes, hepatosplenomegaly, and general failure of the whole blood cells. The diagnosis is based on repeated bone marrow smears and lymph node biopsies for abnormal histiocytes and multinucleated macrophages of various morphologies.
(2) histiocytosis X: also known as Lange-rhan histiocytosis is a group of rare diseases of unknown etiology characterized by the proliferation of well-differentiated histiocytes, involving the liver, spleen, lymph nodes, lungs, bone marrow, skin, etc. The disease is also divided into three types according to the degree of cell differentiation: ①Letterer-Siwe disease, which develops mostly within 1 year of age, with high fever red maculopapular rash respiratory symptoms liver and spleen lymph node enlargement as the main manifestation; ② Han a snow a ke (Hand-Schuller-Christian) disease is mostly seen in children and young people cranial defects proptosis and uveitis as the three main features; ③ bone eosinophilic granuloma is mostly seen in children with long bones and flat bone osteolytic destruction as the main manifestation of the diagnosis and typing of the disease to be based on clinical radiological and pathological examination comprehensive The diagnosis is more accurate if the tissue cells are confirmed to be Langerhans cells.
C. Allergic lymph node enlargement
1.Reactive lymphadenopathy
Certain drugs or biological products can cause fever, rash, lymph node enlargement, etc. Those caused by common chemical drugs are called drug fever, such as callitrizine, methyldopa, isoniazid, phenytoin sodium, etc. Those caused by various vaccines and other biological products are called serum sickness.
2.Adult Sail disease
Adults with juvenile rheumatoid arthritis mainly manifest as chills and high fever lymph nodes, liver and spleen can be mildly enlarged and have a transient red maculopapular rash and muscle and joint pain is not obvious a few can be complicated by multiple pluritis (pericarditis pleurisy, etc.) leukocytosis neutrophils predominantly fast sedimentation but no obvious foci of infection can be found in the blood rheumatoid factor antinuclear antibodies lupus cells, etc. are negative antibiotic therapy is ineffective a lot of salicylic acid The majority of patients have a good prognosis, except for a few years after the occurrence of joint deformities, but can relapse after treatment with adrenal corticosteroids.
3.Allergic subsepsis
Wissler-Fanconi syndrome, also known as Wissler-Fanconi syndrome, is most common in children and is characterized by chronic recurrent fever, recurrent episodes of transient polymorphic rash and joint symptoms, enlarged lymph nodes, liver and spleen, increased white blood cells, rapid sedimentation, and clinically similar to sepsis, but with negative blood and bone marrow cultures. The difference between this disease and adult Still’s disease is that this disease is mostly seen in children with mild joint symptoms and rarely causes joint deformities.
4. Acute necroproliferative lymphadenopathy
The main manifestations are high fever, swollen lymph nodes in the neck, axilla, lung, etc. Superficial lymph nodes with pressure pain, transient leukopenia, ineffective antibiotic treatment, effective corticosteroid treatment, and pathological examination showing extensive coagulative necrosis of lymph nodes surrounded by reactive histiocytes without neutrophil infiltration.
5. Systemic lupus erythematosus (SLE)
Most often seen in young and middle-aged women with long-term irregular fever, typical rash, joint symptoms, symptoms of multi-organ damage, leukocyte reduction, immunological abnormalities, etc. Some cases are accompanied by local or generalized lymph node enlargement.
IV. Other lymph node enlargement
1.Nodular disease
It is a multisystemic granulomatous disease of unknown etiology with enlarged lymph nodes up to the size of walnuts, hard and non-adherent enlarged lymph nodes can be in the upper axilla of the neck and easily invade deep lymph nodes. x-ray can show nodular alveolitis and enlarged hilar and mediastinal lymph nodes with positive skin Kveim test and negative tuberculin skin test. like changes
2. Fatty deposition disease
The common ones are Niemann-Pick disease, Gaucher disease, which occurs in infants and children. Both diseases are clinically similar, with unexplained hepatosplenic lymph node enlargement, bone damage, and neurological symptoms, and allogeneic cytopenia, which is diagnosed and differentiated by the presence of specific foam cells (Niemann-pick cells) and onion skin-like cells (Gaucher cells) in bone marrow and spleen aspirates. The latter can also be found in the bone marrow slides of chronic granulocytic leukemia hodgkin’s disease and multiple myeloma, but they are not deficient in glucocerebrosidase, which can be distinguished.