What percentage of lymphadenopathy presentations to a GP are due to malignancy?
1.1% - consider other causes!
Which is usually more sinister - anterior or posterior chain cervical lymphadenopathy?
Posterior - Lymphoma, TB, Kikuchi's disease, head and neck malignancy
Anterior - usually infection (local or systemic eg EBV/CMV/toxoplasmosis)
Is supraclavicular lymphadenopathy a concern?
Yes - up to 50% of patients with supraclavicular lymphadenopathy have a malignancy. Right-sided supraclavicular lymphadenopathy: mediastinum, lungs, oesophagus Left-sided ("Virchow's node"): adbdominal malignancy
Differentials for trochlear lymphadenopathy
Palpable lymph nodes are ALWAYS pathological. - Local infections - Lymphoma - Rare causes (sarcoidosis, tularaemia, secondary syphilis)
Approach to history-taking in a patient presenting with lymphadenopathy
Distinguishes classical HL from nodular lymphocyte predominant HL - Classical subtypes express CD15 and CD30 but not pan-B or pan-T antigens - NLPHL (usually CD30 and CD15 negative, but CD 20 positive)
What are "popcorn cells" or L&H (lymphocytic and histiocytic cells)
Atypical Reed-Sternberg cells found in nodular lymphocyte predominant Hodgkin Lymphoma (NLPHL)
Typical presentation of Hodgkin Lymphoma
Asymptomatic lymphadenopathy (70%) Incidental finding of mediastinal mass B symptoms (less common: pruritis, pain, cholestatic liver disease, alcohol-induced pain, skin lesions, neurological syndromes, nephrotic syndrome)
Investigations: blood test abnormalities in Hodgkin Lymphoma?
# Hypercalcemia - increased production of calcitriol or bony involvement # Anemia - normochromic and normocytic or Coombs' positive hemolytic anemia # Eosinophilia
# In advanced disease.... Leukocytosis, thrombocytosis, lymphopenia, and hypoalbuminemia
Staging of Hodgkin Lymphoma
Stage I - Single lymph node region (IE - single extralymphatic organ without nodal involvement) Stage II - 2+ lymph node regions same side of the diaphragm (or IIE, with involvement of limited, contiguous extralymphatic organ or tissue) Stage III - Lymph node regions/ lymphoid structures on both sides of diaphragm. Stage IV - Additional noncontiguous extralymphatic involvement +/- associated lymphatic involvement.
International Prognostic Score - what are the factors to consider?
Male gender Age >45 years Stage IV disease Serum albumin <40 Hemoglobin <105 White blood cell count ≥15 Absolute lymphocyte count <0.6 and/or <8 percent of the total white blood cell count.
(none = 84% 5 year survival, all = 42% 5-year survival)