In tropical areas, TB is a main benign cause of LAP in adults and children. In order to provide a comprehensive review of various aspects of peripheral LAP, we performed comprehensive literature search and review through electronic databases, including PubMed, Elsevier, Scholar Google, IranMedex, and Scientific Information Database (SID), using “peripheral lymphadenopathy”, “localization”, “benign”, “malignant”, and “diagnosis” for articles published between 19. In this article, we discuss various aspects of peripheral LAP and describe how a physician can approach it. Several articles have discussed the appropriate approach to the diagnosis and management of LAP. 14, 15 Tissue diagnosis by fine needle aspiration biopsy or excisional biopsy is the gold standard evaluation for LAP. 13 Computed tomography (CT) is useful to determine LAP in the thorax or abdominopelvic cavity. Ultrasound is a noninvasive method to assess lymph nodes in superficial regions like the neck. Imaging can identify the size and distribution of the node more accurately than can physical examination. In unexplained conditions, laboratory tests, imaging studies, and tissue biopsy are recommended. In most cases, further investigation is not required as the cause is obvious on primary evaluation (such as infection). Several aspects in the diagnosis of LAP should be considered. Studies have shown that its prevalence is less than one percent among patients with unexplained LAP in general practice. 9 - 11ĭespite the low prevalence of malignancy among patients with LAP, it remains to be the main concern of both patients and physicians. 4 - 8 Nonetheless, in a large number of studies, the most common benign etiologies are non-specific reactive changes in lymph nodes. For example, tuberculosis (TB) is the most common cause of cervical LAP in endemic areas such as Africa. Based on different geographical areas, the etiology varies. It might be a usual self-limited infection in younger adults or a malignancy in older patients. It is important to take a careful history to consider a variety of disorders, which may be a clue to the underlying disorder. 2 In general, normal lymph nodes are larger in children (ages 2-10), in whom a size of more than 2 cm is suggestive of a malignancy (i.e., lymphoma) or a granulomatous disease (such as tuberculosis or cat scratch disease). For example, some authors have proposed that an inguinal lymph node size up to 1.5 cm should be considered normal, while the normal range for the epitrochlear nodes is up to 0.5cm. Of course, there are exceptions in lymph nodes in different regions and at different ages have different sizes. Lymphadenopathy (LAP) is the term to describe the conditions in which lymph nodes become abnormal in size, consistency, and number.Ī normal sized lymph node is usually less than one cm in diameter. Peripheral lymph nodes are those which are located deep in the subcutaneous tissue and can be palpated if any process causes them to enlarge. 1 Spleen, tonsils, adenoids, and Peyer's patches are parts of the lymphoid tissue, and their role is to clean antigens from the extracellular fluid. The human body has about 600 lymph nodes. We concluded that in patients with peripheral LAP, the patient’s age and environmental exposures along with a careful history taking and physical examination can help the physician to request step by step further work-up when required, including laboratory tests, imaging modalities, and tissue diagnosis, to reach an appropriate diagnosis. Tissue diagnosis by fine needle aspiration biopsy or excisional biopsy is the gold standard evaluation for LAP. Complete history taking and physical examination are mandatory for diagnosis however, laboratory tests, imaging diagnostic methods, and tissue samplings are the next steps. For example, in tropical areas, tuberculosis (TB) is a main benign cause of LAP in adults and children. Based on different geographical areas, the etiology is various. Generally, it is due to infections, but most of the supraclavicular lymphadenopathies are associated with malignancy. Cervical lymph nodes are involved more often than the other lymphatic regions. Seventy-five percent of all LAPs are localized, with more than 50% being seen in the head and neck area. However, it could be a manifestation of underlying malignancy. Peripheral lymphadenopathy (LAP) is frequently due to a local or systemic, benign, self-limited, infectious disease. Generally, a normal sized lymph node is less than one cm in diameter. Peripheral lymph nodes, located deep in the subcutaneous tissue, clean antigens from the extracellular fluid.
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