Lymphadenopathy and lymphoma
Causes and Symptoms (Magill’s Medical Guide, Sixth Edition)
The lymphatic system consists of a large complex of lymph vessels and groups of lymph nodes (“lymph glands”). The lymph vessels include a vast number of capillaries that collect fluid and dissolved proteins, carbohydrates, and fats from tissue fluids. The lacteals of the intestinal villi are lymph vessels that serve to absorb fats from the intestine and transport them to the bloodstream.
Lymph nodes are found throughout the body but are concentrated most heavily in regions of the head, neck, armpits, abdomen, and groin. Nodes function to filter out foreign materials, such as bacteria or viruses, which make their way into lymphatic vessels.
The sizes of lymph nodes vary: Some are as small as a pinhead, some as large as a bean. In general, they are shaped much like kidney beans, with an outer covering. Internally, they consist of a compartmentalized mass of tissue that contains large numbers of B and T lymphocytes as well as antigen-presenting cells (APC). The lymphatic circulation into the lymph nodes consists of a series of entering, or afferent, vessels, which empty into internal spaces, or sinuses. A network of connective tissue, the reticulum, regulates the lymph flow and serves as a site of attachment for lymphocytes and macrophages. The lymphatic circulation leaves the node through efferent, or exiting, vessels in the lower portion of the organ, the hilum.
Among the functions of lymph nodes are...
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Treatment and Therapy (Magill’s Medical Guide, Sixth Edition)
Treatment and other means of dealing with lymphadenopathy depend on the specific cause. In the case of lymph node enlargement that is secondary to infections, treatment of the primary cause is sufficient to restore the normal appearance of the node. For example, in a situation in which nodes in the neck region are enlarged as the result of a throat infection, antibiotic treatment of the primary cause—that is, the bacterial infection—is sufficient. The nodes will resume their normal size after a short time.
Dealing with lymph node enlargement caused by lymphoma requires a much more aggressive form of treatment. There are many kinds of lymphomas, which differ in type of cell involvement and stage of differentiation of the involved cells. The manifestations of most lymphomas, however, are similar. In general, these disorders first present themselves as painless, enlarged nodes. Often, this occurs in the neck region, but in many forms of NHL, the lymphadenopathy may manifest itself elsewhere in the lymphatic system. As the disease progresses, splenomegaly (enlarged spleen) and hepatomegaly (enlarged liver) may manifest themselves. Frequently, the bone marrow becomes involved. If the enlarged node compresses a vital organ or vessel in the body, immediate surgery may be necessary. For example, if one of the veins of the heart is compressed, the patient may be in immediate, life-threatening danger. Treatment generally...
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Perspective and Prospects (Magill’s Medical Guide, Sixth Edition)
What was likely Hodgkin’s disease was first described in 1666 as an illness in which lymphoid tissues and the spleen had the appearance of a “cluster of grapes.” The disorder was invariably fatal. In 1832, Thomas Hodgkin published a thorough description of the disease, including its progression from the cervical region of the body to other lymphatic regions and organs. The unusual histological appearance of the cellular mixture characteristic of Hodgkin’s disease was noted during the nineteenth century. It was early in the twentieth century, however, that Dorothy Reed and Karl Sternberg described the cell that is characteristic of the disorder: the Reed-Sternberg cell. As noted earlier, the number and proportion of such cells are the bases for the classification of the disease.
Two forms of non-Hodgkin’s lymphoma are known to be associated with specific viruses: Burkitt’s lymphoma (BL) and adult T-cell leukemia (ATL). BL was described by Denis Burkitt, who studied the pattern of certain forms of lymphomas among Ugandan children during the late 1950’s. He noted that nearly all cases were found in children between the ages of two and fourteen, and noted that most cases in Africa were found in the malarial belt. Burkitt suspected that a mosquito might be involved in the transmissions of BL. Though no link has been found with arthropod transmission, the idea that BL might be associated with a viral agent...
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For Further Information: (Magill’s Medical Guide, Sixth Edition)
Cerroni, Lorenzo, Kevin Gatter, and Helmut Kerl. Skin Lymphoma: The Illustrated Guide. 3d ed. Hoboken, N.J.: Wiley-Blackwell, 2009. This book is an extremely practical guide to diagnosis that will help any pathologist spot skin lymphoma. It combines stunning pictures of histopathology (tissue specimens) with the clinical features, making it attractive and useful to pathologists and clinicians.
Delves, Peter J., et al. Roitt’s Essential Immunology. 11th ed. Malden, Mass.: Blackwell, 2006. An outstanding textbook on immunology. The early chapters on the lymphatic system, lymph nodes, and the immune response provide an excellent background for the subject.
Greer, John, et al., eds. Wintrobe’s Clinical Hematology. 12th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health, 2009. A textbook of hematologic disorders, with an excellent review of lymphatic diseases, including Hodgkin’s disease. Written for clinicians and students of medicine.
Holman, Peter, and Jodi Garrett. One Hundred Questions and Answers About Lymphoma. 2d ed. Sudbury, Mass.: Jones and Bartlett, 2011. A patient-oriented guide that covers a range of topics related to lymphatic diseases, including risk factors and causes; methods of prevention, screening, and diagnosis; available treatments and how to choose among them; and ways of coping with common emotional and physical...
(The entire section is 425 words.)