Page 154 - Essential Haematology

140 / Chapter 9 White cells: Lymphocytes

cytotoxic chemotherapy or radiotherapy and is par- infectious or malignant disease, whether the nodes
ticularly pronounced after stem cell transplantation are painful or tender, consistency of the nodes and
where dysregulation of the immune system persists whether there is generalized or local lymphadenopa-

for 1 year or more and is responsible for a high thy are all important. The size of the liver and
incidence of serious viral infections (e.g. with spleen are assessed. In the case of local node enlarge-

cytomegalovirus or herpes zoster). Alemtuzemab ment, inflammatory or malignant disease in the
(anti - CD52) causes a similar immunodefi ciency. associated lymphatic drainage area are particularly

Immunodeficiency is also frequently associated with considered.
tumours of the lymphoid system including chronic Further investigations will depend on the initial
lymphocytic leukaemia and myeloma. clinical diagnosis but it is usual to include a full

blood count, blood film and erythrocyte sedimenta-
tion rate (ESR). Chest X - ray, monospot test,
Differential d iagnosis of cytomegalovirus and Toxoplasma titres, and anti -
HIV and Mantoux tests are frequently needed. In
l ymphadenopathy
many cases, it will be essential to make a histological
The principal causes of lymphadenopathy are listed diagnosis by node biopsy, usually trucut, in which

in Figure 9.12 . The clinical history and examination a core of node is removed under radiological control.

give essential information. The age of the patient, Fine needle aspirates give less material, destroy the

length of history, associated symptoms of possible architecture and so are less reliable in diagnosis.

Localized Generalized

Local infection Infection
• pyogenic infection, • viral, e.g. infectious
e.g. pharyngitis, mononucleosis,
dental abscess, measles, rubella,
otitis media, viral hepatitis, HIV
actinomyces • bacterial, e.g. syphilis,
• viral infection brucellosis,tuberculosis,
• cat scratch fever Salmonella, bacterial
• lymphogranuloma venereum endocarditis
• tuberculosis • fungal, e.g. histoplasmosis
• protozoal, e.g. toxoplasmosis
Lymphoma
• Hodgkin lymphoma Non-infectious inflammatory
• non-Hodgkin lymphoma diseases, e.g. sarcoidosis,
Carcinoma (secondary) rheumatoid arthritis, SLE,
other connective tissue diseases,
serum sickness
Malignant
• leukaemias, especially CLL, ALL
• lymphoma: non-Hodgkin lymphoma,
Hodgkin lymphoma
• rarely secondary carcinoma
• angioimmunoblastic lymphadenopathy
Miscellaneous
• sinus histocytosis with massive lymphadenopathy
(Rosai–Dorfman)
• reaction to drugs and chemicals, e.g. hydantoins
and related chemicals, beryllium
• hyperthyroidism

Figure 9.12 Causes of lymphadenopathy. ALL, acute lymphoblastic leukaemia; CLL, chronic lymphocytic

leukaemia; SLE, systemic lupus erythematosus. Malignancies are listed in red.