Hyperplasia of lymph nodes

Hyperplasia of the lymph nodes is one of the serious problems of 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 kind and localization. This process can begin anywhere, and its result is an increase in the volume of tissues. 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 attribute it to lymphadenopathy - increased formation of lymphoid tissue, which causes their increase. And the lymph nodes are known to increase in response to any infection and inflammation.

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

Causes of lymph node hyperplasia

Characterizing the causes of lymph node hyperplasia, it is necessary to clarify that the 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 organs of the lymphatic system : regional lymph nodes, spleen, thymus, pharyngeal tonsils. This tissue is also present in the bone marrow, in the mucous membranes of the respiratory system, gastrointestinal tract and urinary tract. And if there is a focus of chronic inflammation in some body, clusters of cells of lymphoid tissue appear also there - in order to protect the body from the attacking infection.

But we are interested in regional lymph nodes that provide the production of lymphocytes and antibodies, the filtration of lymph and the regulation of its currents from the organs. To date, the causes of hyperplasia of lymph nodes are considered as the reasons for their increase, which is the immune response to any pathological process that makes changes both in the dynamics of tissue metabolism of the lymph node, and in the ratio of certain cells. For example, in response to genetically distinct cells (antigens) in the lymph node, the production of lymphocytes and mononuclear phagocytes (macrophages) increases; when bacteria and microbes get into the lymph nodes, they accumulate the products of their vital activity and neutralized toxins. 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 the size, a change in the shape and structure of the fibrous capsule of the lymph node. Moreover, the tissues of the lymph nodes can sprout beyond the capsule, and in the case of metastases from other organs, they are replaced by their malignant cells.

Proceeding from this, the hyperplasia of the lymph nodes can be infectious, reactive or of malignant origin.

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

Hyperplasia of lymph nodes of infectious etiology

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

With nonspecific lymphadenitis - depending on the location - there is hyperplasia of the lymph nodes in the neck, lower jaw or axillary lymph nodes. The increase in axillary lymph nodes was noted in mastitis, inflammation of the joints and muscle tissues of the upper extremities, brucellosis, felinosis, etc.

For inflammatory processes in the oral cavity and nasopharynx (with actinomycosis, caries, chronic tonsillitis, pharyngitis, bronchitis, etc.), hyperplasia of the submaxillary lymph nodes, behind-the-ear, pre-percutaneous and zagochlorous is characteristic. And with infectious mononucleosis, only the cervical lymph nodes increase.

In the case of rubella, toxoplasmosis, tuberculosis, as well as with syphilis, doctors detect hyperplasia of cervical lymph nodes. In addition, in the symptomatology of tuberculosis, hyperplasia of the intrathoracic and mediastinal lymph nodes is noted. At the same time in the lymph nodes there is a gradual replacement of healthy cells of lymphoid tissue with necrotic masses of a caseous character.

Tuberculosis and hyperplasia of mesenteric lymph nodes are characteristic. In addition, a significant increase in the lymph nodes of the mesenteric part of the small intestine occurs as a result of the lesion of the Gram-negative bacterium Francisella tularensis, which causes tularemia, an acute infectious disease carried by rodents and arthropods.

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

Symptoms of lymph node hyperplasia

Hyperplasia of the lymph nodes, as mentioned above, is a symptom of a wide range of diseases. The most important task is to identify the symptoms of lymph node hyperplasia, confirming or refuting the malignant pathogenesis of increased cell division.

If the lymph node grows quickly (up to 2 cm and slightly more), if you feel pain while feeling, and the consistency of the node is rather mild and elastic, that is, all the grounds to assert: this lymph node hyperplasia was caused by infection or inflammation. This is confirmed by the reddening of the skin in the lymph node.

When the lymph node increases slowly, when palpation does not cause pain, and the node itself is very dense - the likelihood of the process being of a malignant nature is high. And with metastases, the enlarged lymph node literally grows into surrounding tissues and can form "colonies".

The localization of the hypertrophic lymph node also matters. Hyperplasia of the submaxillary, cervical and axillary lymph nodes speaks in favor of its good quality. What can not be said about hyperplasia of supraclavicular, lymph nodes of the mediastinum, retroperitoneal and lymph nodes in the abdominal cavity.

Reactive lymph node hyperplasia

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

• autoimmune collagenoses (rheumatoid arthritis and polyarthritis, nodular periarteritis, systemic lupus erythematosus, scleroderma, Hammen-Rich syndrome, Wegener's granulomatosis); - Wagner's disease or dermatomyositis (a systemic disease of skeletal and smooth muscles and skin)
• accumulation diseases (eosinophilic granuloma, Gaucher's disease, Niemann-Pick disease, Leterer-Ziva disease, Hyunda-Schuller-Crischen disease).

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

Among autoimmune diseases of the endocrine system, lymph node hyperplasia is characteristic of hyperthyroidism (Based's disease), the cause of which lies in the increased thyroid gland secretion of thyroid hormones. With this pathology, lymph node hyperplasia has a generalized character 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 follicular hyperplasia of the lymph nodes is significantly larger than the norm of lymphoproliferation, the size and amount of secondary follicles that form antibodies, as well as the expansion of their reproductive centers (the so-called bright centers). These processes occur in the cortex of the lymph nodes. In this case, the secondary follicles behave quite aggressively, displacing the remaining cells, including lymphocytes.

Follicular hyperplasia of the lymph nodes in the neck is diagnosed as a characteristic symptom of angiofollikular lymphoid hyperplasia or Castleman's disease. With the localized form of this disease, only one lymph node is enlarged, but this is manifested by periodic pain in the chest or abdominal region, weakness, weight loss, fever attacks. The cause of the disease Castleman researchers attributed to the presence in the body of the herpes virus HHV-8.

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

Malignant hyperplasia of lymph nodes

Hyperplasia of lymph nodes of malignant etiology can affect regional nodes throughout the body. Lymphomas are primary.

Prolonged enlargement of the supraclavicular lymph nodes can talk about cancer of the esophagus, stomach, duodenum, intestines, kidneys, ovaries, testicles.

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

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

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

With Hodgkin's lymphoma, as a rule, there is a persistent increase in cervical and supraclavicular nodes, as well as hyperplasia of retroperitoneal and lymph nodes of the abdominal cavity. Significant dimensions of the latter cause disruption of the bowel and pelvic organs. In the case of non-Hodgkin's lymphoma, on the background of anemia, neutrophilic leukocytosis and lymphopenia, there is hyperplasia of the cervical and intrathoracic lymph nodes (near the diaphragm), as well as nodes in the ulnar and popliteal folds.

Diagnosis of lymph node hyperplasia

Diagnosis of lymph node hyperplasia should take into account and correctly assess all the factors that led to the onset of this syndrome. Therefore, a comprehensive survey is needed, which includes:

• general blood analysis,
• biochemical blood test (including on toxoplasmosis and antibodies),
• immunogram of blood,
• analysis on tumor markers,
• general urine analysis,
• The smear from the throat for the presence of pathogenic flora,
• serological tests for syphilis and HIV,
• Pirke and Mantoux test for tuberculosis,
• Kweim's test for sarcoidosis,
• radiography (or chest X-ray)
• ultrasound (ultrasound) of lymph nodes,
• lymphoscintigraphy;
• biopsy (puncture) of the lymph node and histological examination of the biopsy specimen.

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

[26], [27]

Treatment of lymph node hyperplasia

Treatment of lymph node hyperplasia depends on the cause of its appearance, and therefore a single therapeutic scheme is not and can not be. But, as doctors say, in any case, complex therapy is necessary.

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

In the treatment associated with tuberculosis or other specific infection, treatment is prescribed according to the schemes developed for each specific disease.

In the case of a diagnosed autoimmune disease that results in the appearance of lymph node hyperplasia, or the malignant nature of the proliferation of lymph node cells, no compresses and 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 hyperplasia of lymph nodes - timely examination and treatment, and with incurable pathologies - the implementation of all the recommendations of experienced and knowledgeable doctors. Then it is possible not to bring the disease to extremes, when hypertrophied tissues will turn into malignant neoplasm.

Prognosis of lymph node hyperplasia

Any prognosis of lymph node hyperplasia - with such a diverse "assortment" of its pathogenesis - rests on the root cause. With nonspecific infection, the prognosis is most positive. However, there are some nuances here: any "elementary" and enlarged and inflamed lymph nodes - in the absence of proper diagnosis and adequate treatment - can lead to either sepsis or admission to an oncologist with lymphoma ...