Cervical Lymphadenopathy - Symptoms, Treatment of Cervical Lymphadenopathy

Cervical Lymphadenopathy is a common disease generally seen in children and the majority will experience some form of cervical lymph node enlargement between 2 and 12 years old. It is a Reed-Sternberg cell and the diagnosis is that of Hodgkin's lymphoma.  Non Hodgkins Lymphoma is a common type of lymphoma found in the U.K. which might be present in different ways. Cervical Lymphadenopathy is caused by Staphylococcus Aureus or Group A Streptococcus (Strep pyogenes). Cervical lymph nodes are weigh stations of lymphatic drainage. They are divided into several anatomical groups that we all know very well. The anterior triangle drains the face, nasopharynx, oral cavity and oropharynx. These nodes are commonly identified in cervical lymphadenitis, while the supraclavicular and posterior triangle nodes are involved less commonly. Cervicofacial lymph nodes may reside in the anterior triangle forward of the sternocleidomastoid muscle, the posterior triangle behind the sternocleidomastoid, the submandibular region below the jaw line, the supraclavicular region in the lower neck, and the preauricular and occipital regions. There are other primary sites with low occult metastatic disease rates.

Lymphadenopathy can be caused by an increase in normal lymphocytes and macrophages during a response to an antigen (eg, viral illness), nodal infiltration by inflammatory cells in response to an infection in the nodes themselves. Diagnosis of cervical lymphadenopathy disease is important for patients with head and neck cancers as it helps the assessment of patient prognosis and the selection of treatment method. Bacterial lymphadenitis is by far the most common etiology, and is most often due to upper respiratory tract infections that seed the regional lymph nodes. Tuberculous cervical lymphadenitis is the most common extrapulmonary presentation of TB and is seen in about 5%-10% of tuberculous children. Sex is not a major factor associated with lymphadenopathy.

Types of Cervical Lymphadenopathy

• Lymphocyte predominant (5%) - best prognosis
• Nodular sclerosing (65%) - worst prognosis
• Mixed cellularity (25%)
• Lymphocyte depleted (5%)

Causes of Cervical Lymphadenopathy

• Bacterial infection of the upper extremities
• Lymphoma
• Upper respiratory tract infection
• Cat scratch disease
• Thyroid carcinoma
• Tonsillitis
• Upper respiratory tract infection
• Vincent's angina
• Lyme disease
• Toxoplasmosis
• Metastasis
• Sarcoidosis
• Autoimmune
• Drug induced pseudolymphoma

Treatment

Diagnosis can be made with the indirect fluorescent antibody test. Although infection is a common cause of lymphadenopathy in children, the identification of the specific causative organism may be extremely difficult. If lymphadenitis is present, aspirate may be needed for culture, and removal of the affected node may be indicated.

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