Evaluation of the patient with lymphadenopathy: Is it always easy to reach the correct diagnosis?

Lymphadenopathy (LAP) is a common clinical problem in adult patients and should be thoroughly evaluated in a tertiary hospital to investigate its reasons. In this study, we aimed to present the demographic characteristics, etiology, diagnosis and follow-up results of the patients who applied with LAP symptoms and findings. This study was designed to include adult patients with neck, armpit, or groin swelling accompanied by symptoms, such as fever, night sweats, weight loss, cough and sputum between January 2010 and August 2017, retrospectively. Patients’ data were collected from electronic files. Patients were diagnosed using radiological, histopathological, bacteriological, serological and other microbiological methods. Two hundred-thirty patients were included in this study. The mean age was 43.12±17.06 SD in males and 45.74±16.64 in females. On admission, the most common symptoms were night sweats (31%), fever (23%), weight loss (17%) and cough and/or sputum (13%) in order of frequency. However, 16% of the patients were asymptomatic. In this study, 157 (68.26%) patients were diagnosed. Tuberculosis (n=76; 33%), malignancies (n=28, 12.1%) and tularemia (N=14; 6.1%) were the most common diseases causing LAP that was most commonly located in the bilateral cervical chain. Lymphadenopathy should be evaluated comprehensively concerning diagnosing or ruling out many diseases that must be treated necessarily. Knowledge and awareness of the diseases as a cause of LAP may contribute to the early and correct diagnosis. Therefore, undiagnosed patients should be followed, and the institutions should develop policies for this purpose, such as telemedicine applications.

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1. Morland B. Lymphadenopathy. Arch Dis Child. 1995;73:476-9.

2. Fijten GH, Blijham GH. Unexplained lymphadenopathy in family practice. An evaluation of the probability of malignant causes and the effectiveness of physicians’ workup. J Fam Pract. 1988;27:373-6.

3. Gaddey HL, Riegel AM. Unexplained Lymphadenopathy: Evaluation and Differential Diagnosis Am Fam Physician. 2016:1;94:896-903.

4. Habermann TM, Steensma DP. Lymphadenopathy. Mayo Clin Proc. 2000;75:723-32.

5. Viiala N, Gibson J [Internet]. An approach to the assessment of lymphadenopathy. [cited 2007 Jan 10 ]. Available from: http://www. medicalobserver.com.au/news/an-approachto-the-assessment-oflymphadenopathy.

6. Bazemore AW, Smucker DR. Lymphadenopathy and malignancy. Am Fam Physician. 2002;66:2103-10.

7. Chau I, Kelleher MT, Cunningham D, et al. Rapid access multidisciplinary lymph node diagnostic clinic: analysis of 550 patients. Br J Cancer. 2003;88:354-61.

8. Haynes J, Arnold KR, Oskıns CA, et al. Evaluation of neck masses in adults. Am Fam Physician. 2015;91:698-706.

9. Richner S, Laifer G. Peripheral lymphadenopathy in immunocompetent adults. Swiss Med Wkly 2010;140:98-104.

10. Gul M, Aliosmanoglu I, Turkoglu A, et al. Erişkin çağı periferik lenfadenopatileri. Dicle Tıp Dergisi 2013;40:245-9.

11. Bosch X, Coloma E, Donate C, et al. Evaluation of unexplained peripheral lymphadenopathy and suspected malignancy using a distinct quick diagnostic delivery model: prospective study of 372 patients. Medicine (Baltimore). 2014;93:e95.

12. Mbata GC, Nweke IG, Egejuru RO, et al. South eastern histologic pattern of lymph node biopsies in a tertiary hospital in Nigeria. J AIDS Clin Res. 2015;6:6:475-8.

13. Lee Y, Terry R, Lukes RJ. Lymph node biopsy for diagnosis: a statistical study. J Surg Oncol. 1980;14:53-60.

14. Deveci HS, Kule M, Kule ZA, et al. Diagnostic challenges in cervical tuberculous lymphadenitis: A review. North Clin Istanb. 2016;3:150–5.

15. Albayrak N, Celebi B, Kavas S, et al. Investigation of the presence of Mycobacterium tuberculosis in the lymph node aspirates of the suspected tularemia lymphadenitis cases. Mikrobiyol Bul. 2014;48:129-34.

16. Rahman A, Biswas MA, Siddika TS, Sikder AM. Histopathological Evaluation of Lymph Node Biopsies: A Hospital Based Study. J Enam Med Col. 2012;2(1):8-14.

17. Shah KK, Pritt BS, Alexandera MP. Histopathologic review of granulomatous inflammation. J Clin Tuberc Other Mycobact Dis. 2017;7:1–12.

18. Mohseni S, Shojaiefard A, Khorgami Z, et al. Peripheral lymphadenopathy: approach and diagnostic tools. Iran J Med Sci. 2014;39:158–70.

19. Ochicha O, Edino ST, Mohammed AZ, et al. Pathology of peripheral lymph node biopsies in Kano, Northern Nigeria. Ann Afr Med. 2007;6:104-8.

20. Pangalis GA, Vassilakopoulos TP, Boussiotis VA, et al. Clinical approach to lymphadenopathy. Semin Oncol. 1993;20:570-82.

21. Kartal O, Ataş E, Gürsel O. Differentiation of benign from malignant cervical lymphadenopathy by ultrasonography in children. Arch Argent Pediatr. 2020;118:11-7.

22. Saraswat A, Rajender A, Purohit K, et al. Lymph node biopsy: Spectrum and clinical significance as diagnostic tool at tertiary care centre. J Evolution of Med Dental Sci. 2015;4:1008-15.

23. Penn RL. Francisella tularensis (tularemia). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders, 2015:2590-602.

24. Kılıç UA, Kılıç S, Sencan I, et al. A water borne tuleremia outbreak caused by Francisella tularensis subspecies holarctica in Central Anatolia region. Mikrobiyol Bul. 2011;45:234-47.

25. Erdem et al. Evaluation of tularaemia courses: a multicentre study from Turkey. Clin Microbiol Infect 2014;20:1042–51.

26. Clarke P, Valadares CN, Balabram D, Pires DM. Bilateral axillary lymphadenopathy: differential diagnosis and management. Mastology 2020;30:e20200036.

27. Medina RP, Guio JI, Correa PL. Localized Castleman's Disease in the Breast in a Young Woman. Case Rep Pathol. 2016;2016:8413987.

28. Talabi OA. Melkerssons-Rosenthal syndrome: a case report and review of the literatüre. Niger J Clin Pract. 2011;14:477-8.
Medicine Science-Cover
  • ISSN: 2147-0634
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2012
  • Yayıncı: Effect Publishing Agency ( EPA )
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