Lymph node hyperplasia

Lymph node hyperplasia is a serious problem in clinical medicine.

In fact, hyperplasia (Greek - over-education) is a pathological process associated with an increase in the intensity of reproduction (proliferation) of tissue cells of any type and localization. This process can begin anywhere, and its result is an increase in tissue volume. And, in fact, such hypertrophic cell division leads to the formation of tumors.

However, it should be noted that lymph node hyperplasia is not a disease, but a clinical symptom. And many experts classify it as lymphadenopathy - increased formation of lymphoid tissue, which causes their enlargement. And lymph nodes, as is known, enlarge in response to any infections and inflammations.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ], [ 10 ], [ 11 ]

Causes of lymph node hyperplasia

When characterizing the causes of lymph node hyperplasia, it is necessary to clarify that lymphoid or lymphatic tissue (consisting of reticuloendothelial cells, T-lymphocytes, B-lymphocytes, lymphatic follicles, macrophages, dendrites, lymphoblasts, mast cells, etc.) is found not only in the parenchyma of the lymphatic system organs: regional lymph nodes, spleen, thymus glands, pharyngeal tonsils. This tissue is also present in the bone marrow, in the mucous membranes of the respiratory organs, gastrointestinal tract and urinary tract. And if there is a focus of chronic inflammation in any organ, clusters of lymphoid tissue cells appear there as well – to protect the body from the infection attacking it.

But we are interested in regional lymph nodes, which provide the production of lymphocytes and antibodies, filtration of lymph and regulation of its flow from organs. Today, the causes of lymph node hyperplasia are considered as the causes of their enlargement, which is an immune response to any pathological process that changes both the dynamics of tissue metabolism of the lymph node and the ratio of certain cells. For example, in response to genetically different cells (antigens), the lymph node increases the production of lymphocytes and mononuclear phagocytes (macrophages); when bacteria and microbes enter the lymph nodes, their waste products and neutralized toxins accumulate. And in the case of oncology, lymph node hyperplasia can involve any of their cells in the pathological process of proliferation. This causes an increase in size, a change in the shape and structure of the fibrous capsule of the lymph node. Moreover, lymph node tissue can grow beyond the capsule, and in the case of metastases from other organs, be displaced by their malignant cells.

Based on this, lymph node hyperplasia can be of infectious, reactive or malignant origin.

[ 12 ], [ 13 ], [ 14 ], [ 15 ], [ 16 ], [ 17 ], [ 18 ]

Infectious lymph node hyperplasia

Hyperplasia of the lymph nodes (meaning an increase in their size) is a response to infection in diseases such as lymphadenitis caused by streptococci or staphylococci, rubella, chickenpox, infectious hepatitis, felinosis (cat scratch disease); tuberculosis, HIV, infectious mononucleosis, cytomegalovirus, tularemia, brucellosis, chlamydia, syphilis, actinomycosis, leptospirosis, toxoplasmosis.

In non-specific lymphadenitis, depending on the localization, hyperplasia of the lymph nodes in the neck, lower jaw, or axillary lymph nodes is observed. An increase in axillary lymph nodes is noted in mastitis, inflammation of the joints and muscle tissue of the upper extremities, brucellosis, felinosis, etc.

For inflammatory processes in the oral cavity and nasopharynx (in actinomycosis, caries, chronic tonsillitis, pharyngitis, bronchitis, etc.) hyperplasia of the submandibular lymph nodes, postauricular, prelaryngeal and retropharyngeal is characteristic. And in infectious mononucleosis, only the cervical lymph nodes are enlarged.

In the case of rubella, toxoplasmosis, tuberculosis, and syphilis, doctors note hyperplasia of the cervical lymph nodes. In addition, hyperplasia of the intrathoracic and mediastinal lymph nodes is noted in the symptoms of tuberculosis. At the same time, healthy cells of the lymphoid tissue are gradually displaced by necrotic masses of a caseous nature in the lymph nodes.

Hyperplasia of the mesenteric lymph nodes is also characteristic of tuberculosis. In addition, a significant increase in the lymph nodes of the mesenteric part of the small intestine occurs due to damage by the gram-negative bacterium Francisella tularensis, which causes tularemia - an acute infectious disease transmitted by rodents and arthropods.

Hyperplasia of the inguinal lymph nodes is noted by doctors in infectious mononucleosis, toxoplasmosis, brucellosis and actinomycosis, as well as in all infections of the genital tract and HIV.

Symptoms of lymph node hyperplasia

As mentioned above, lymph node hyperplasia is a symptom of a wide range of diseases. The most important task is to identify the symptoms of lymph node hyperplasia that confirm or refute the malignant pathogenesis of increased cell division.

If the lymph node increases rapidly (up to 2 cm and slightly more), if there are painful sensations when palpating, and the consistency of the node is quite soft and elastic, then there is every reason to assert: this is lymph node hyperplasia caused by an infectious lesion or an inflammatory process. This is confirmed by reddening of the skin in the lymph node area.

When a lymph node enlarges slowly, there is no pain when palpated, and the node itself is very dense, there is a high probability that the process is malignant. And with metastases, the enlarged lymph node literally grows into the surrounding tissues and can form "colonies".

The localization of the hypertrophied lymph node is also important. Hyperplasia of the submandibular, cervical and axillary lymph nodes speaks in favor of its benign nature. The same cannot be said about hyperplasia of the supraclavicular, mediastinal, retroperitoneal and abdominal lymph nodes.

Reactive lymph node hyperplasia

Reactive hyperplasia of lymph nodes occurs as a response of the immune system to pathologies of an immune nature. Such pathologies include:

• autoimmune collagenoses (rheumatoid arthritis and polyarthritis, periarteritis nodosa, systemic lupus erythematosus, scleroderma, Hamman-Rich syndrome, Wegener's granulomatosis); - Wagner's disease or dermatomyositis (systemic disease of skeletal and smooth muscles and skin)
• storage diseases (eosinophilic granuloma, Gaucher disease, Niemann-Pick disease, Letherer-Sieve disease, Hand-Schüller-Christian disease).

In addition, the reactive form may accompany serum sickness (allergy to the use of immune serum preparations of animal origin), hemolytic anemia (hereditary or acquired), megaloblastic anemia or Addison-Biermer disease (which occurs with a deficiency of vitamins B9 and B12) and chemotherapy and radiation therapy for cancer.

Among autoimmune diseases of the endocrine system, lymph node hyperplasia is characteristic of hyperthyroidism (Graves' disease), the cause of which lies in the increased production of thyroid hormones by the thyroid gland. In this pathology, lymph node hyperplasia is generalized with increased mitosis of lymphatic follicles.

Experts emphasize that reactive lymph node hyperplasia is characterized by significant proliferative activity and, as a rule, affects the lymph nodes in the neck and lower jaw.

From the point of view of cytomorphology, the reactive form has three types, the most common of which is the follicular form.

Follicular hyperplasia of lymph nodes

Histological studies have shown that the peculiarity of follicular hyperplasia of the lymph nodes is the size and quantity of secondary follicles that form antibodies, significantly exceeding the norm of lymphoproliferation, as well as the expansion of their reproduction centers (the so-called light centers). These processes occur in the cortex of the lymph nodes. In this case, the secondary follicles behave quite aggressively, displacing other cells, including lymphocytes.

Follicular hyperplasia of the lymph nodes in the neck area is diagnosed as a characteristic symptom of angiofollicular lymphoid hyperplasia or Castleman's disease. In the localized form of this disease, only one lymph node is enlarged, but this is manifested by periodic pain in the chest or abdomen, weakness, weight loss, and fever attacks. Researchers associate the cause of Castleman's disease with the presence of the herpes virus HHV-8 in the body.

[ 19 ], [ 20 ], [ 21 ], [ 22 ], [ 23 ], [ 24 ], [ 25 ]

Malignant hyperplasia of lymph nodes

Malignant lymph node hyperplasia may affect regional nodes throughout the body. Primary lymphomas are considered primary.

Long-term enlargement of the supraclavicular lymph nodes may indicate cancer of the esophagus, stomach, duodenum, intestines, kidneys, ovaries, or testicles.

Hyperplasia of the cervical lymph nodes is observed in tumors of the maxillofacial localization, in melanoma in the head and neck area. In patients with tumors of the lungs or mammary glands, oncopathology will necessarily manifest itself as hyperplasia of the axillary lymph nodes. In addition, it occurs in blood cancer.

Hyperplasia of the cervical and mediastinal lymph nodes is characteristic of sarcoidosis (with the formation of epithelioid cell granulomas and their subsequent fibrosis).

In leukemia, malignant neoplasms in the pelvic organs, metastases of prostate cancer, uterus, ovaries, and rectum, hyperplasia of the lymph nodes in the abdominal cavity and inguinal lymph nodes is usually observed.

In Hodgkin's lymphoma, persistent enlargement of the cervical and supraclavicular nodes, as well as hyperplasia of the retroperitoneal and abdominal lymph nodes, are usually observed. The significant size of the latter causes dysfunction of the intestines and pelvic organs. In the case of non-Hodgkin's lymphoma, hyperplasia of the cervical and intrathoracic lymph nodes (in the diaphragm area), as well as nodes in the elbow and popliteal folds, is detected against the background of anemia, neutrophilic leukocytosis and lymphopenia.

Diagnostics of lymph node hyperplasia

The diagnosis of lymph node hyperplasia must take into account and correctly assess all the factors that led to the occurrence of this syndrome. Therefore, a comprehensive examination is necessary, which includes:

• complete blood count,
• biochemical blood test (including toxoplasmosis and antibodies),
• blood immunogram,
• tumor marker analysis,
• general urine analysis,
• throat swab for the presence of pathogenic flora,
• serological tests for syphilis and HIV,
• Pirquet and Mantoux tests for tuberculosis,
• Kveim test for sarcoidosis,
• chest x-ray (or fluorography),
• ultrasound examination (ultrasound) of the lymph nodes,
• lymphoscintigraphy;
• biopsy (puncture) of the lymph node and histological examination of the biopsy.

In half of the cases, an accurate diagnosis is only possible with the help of a histological examination after taking a tissue sample from the lymph node.

[ 26 ], [ 27 ]

Treatment of lymph node hyperplasia

Treatment of lymph node hyperplasia depends on the cause of its occurrence, and therefore there is no and cannot be a single therapeutic scheme. But, as doctors say, in any case, complex therapy is necessary.

If the enlargement of the lymph node is caused by an inflammatory process, it is necessary to fight the infection that led to the inflammation. For example, when treating acute lymphadenitis at the early stages of the disease, compresses are used, but with purulent inflammation they are strictly prohibited. Doctors prescribe antibiotics to such patients - taking into account the resistance of specific pathogenic microorganisms to them. Thus, most staphylococci are resistant to drugs of the penicillin group, neutralizing the effect of the drug with the help of the beta-lactamase enzyme. It is also recommended to take vitamins and undergo a course of UHF therapy.

When treating tuberculosis or other specific infections, treatment is prescribed according to regimens developed for each specific disease.

In case of a diagnosed autoimmune disease that has caused lymph node hyperplasia or malignant proliferation of lymph node cells, no compresses or antibiotics will help. Keep in mind that in the case of lymph nodes and pathological proliferation of their tissues, self-medication is absolutely unacceptable!

Prevention of lymph node hyperplasia is timely examination and treatment, and in case of incurable pathologies - following all recommendations of experienced and knowledgeable doctors. Then it is possible not to bring the disease to extremes, when hypertrophied tissues turn into a malignant neoplasm.

Prognosis of lymph node hyperplasia

Any prognosis for lymph node hyperplasia – with such a diverse “range” of its pathogenesis – rests on the root cause. With a non-specific infection, the prognosis is the most positive. However, there are nuances here: any even “elementary” enlargement and inflammation of the lymph nodes – in the absence of correct diagnosis and adequate treatment – has every chance of leading either to sepsis or to an appointment with an oncologist with lymphoma…