ADENOMEGALY: TYPES, SYMPTOMS, CAUSES, TREATMENTS - MEDICINE - 2024

The adenomegalia is the growth of lymph nodes in one or more regions of the body; This growth is a consequence of the reaction of the lymph nodes (which are part of the immune system) to some benign or malignant pathological process.

The body's natural response to some type of disease is the clonal expansion of T and B lymphocytes in order to respond to aggression. Since part of this process occurs in the lymph nodes, when there is an inflammatory, infectious or neoplastic condition, the lymph nodes in the area increase in size.

Source: By Meher Aziz, Prasenjit Sen Ray, Nazima Haider, and Sumit Prakash Rathore. https://creativecommons.org/licenses/by/3.0/ ("Attribution 3.0 Unported (CC BY 3.0)")

From the clinical point of view, adenomegalies are identified by palpation of the nodes in the regional lymphatic chains. The spectrum of clinical findings ranges from palpation of enlarged nodes without any other associated symptoms, to painful nodes, with redness of the overlying skin and even fever.

Depending on the age and clinical conditions of the patient, both the cause and the characteristics of lymph nodes can vary. Due to this, clinical and laboratory evaluation are essential to be able to reach an accurate diagnosis and thus be able to establish an adequate treatment. In some cases it is even necessary to perform a lymph node biopsy in order to reach a definitive diagnosis.

Types

There are different types of classification for adenomegalies depending on their clinical characteristics and time of evolution; These systems are not exclusive; on the contrary, they complement each other, helping to establish a precise etiological diagnosis.

Thus, according to the time of evolution, adenomegalies are classified as acute and chronic; on the other hand, when they are classified according to their cause, adenomegalies can be of benign or malignant origin.

Acute adenomegaly

Adenomegaly, or adenomegalic syndrome as it is often called in medicine, is considered acute when it appears suddenly (between a few hours and a few days of evolution) and does not persist for more than 15 days.

They are usually very frequent in children, associated with fever and general malaise; In these cases, the main cause is usually viral diseases, although other pathologies cannot be ruled out from the outset without having studied the patient in detail.

Chronic adenomegaly

Adenomegaly is classified as chronic when it persists for more than 15 days after its appearance. In these cases, the adenomegaly can persist for months or even years, whether or not it is associated with other symptoms.

In general, chronic adenomegalies are seen in adult patients and are associated with chronic granulamotic diseases such as tuberculosis or leprosy; likewise they are frequent in certain types of cancer.

Adenomegaly of benign origin

Also known as reactive adenomegalies or adenitis, adenomegalies of benign origin are usually associated with inflammatory, infectious diseases or trauma that usually resolve without leaving sequelae for the patient.

They are generally acute (although there are exceptions) and are associated with other symptoms such as malaise, fever, and in some cases skin rashes.

The clinical diagnosis is essential to be able to decide the best treatment, although in most cases this will be aimed at controlling the symptoms since this type of lymph node enlargement (and the diseases associated with it) are usually self-limited.

Adenomegaly of malignant origin

Adenomegaly is considered to be of malignant origin when the growth of the ganglion is due to the infiltration of malignant tumor cells.

If the cancer originated in the lymph nodes, it is called Lymphomas. In these cases, the origin of the cancer is the cells of the lymph node itself and from there they can migrate to other areas of the body.

On the other hand, when cancer cells have originated in another organ and reach the node, it is referred to as lymph node metastasis, this being an indication of the spread of the primary cancer beyond the site of origin.

Generally, adenomegalies of malignant origin are of chronic evolution. However, in some cases early detection and aggressive clinical study allow the diagnosis of a metastasis or primary node tumor to be detected before the node has evolved more than 15 days.

Symptoms

Adenomegaly can be considered in itself a symptom of a pathological process beyond the lymph node. In this sense, lymph node growth may or may not be associated with other symptoms.

The cardinal symptom in all cases is the enlargement of the lymph node, but… when is a lymph node considered to be enlarged?

Well, clinically the lymph nodes should not be palpable under normal conditions, therefore it is considered that when these structures are detectable by palpating the lymph node chains during the physical examination, it is because their size is already greater than normal.

In this sense, the consistency of the lymph nodes is very useful to guide the diagnosis. In cases of benign or chronic granulomatous pathology, the nodes are usually of a stony consistency (similar to rubber), while in cases of malignant disease the nodes are usually stone.

In many cases, adenomegaly presents as an isolated clinical finding not associated with other obvious symptoms, while in others there are concomitant findings such as pain (in the ganglion), fever, redness of the overlying skin and in some cases even purulent discharge.

Causes

The causes of adenomegaly are multiple and varied, in fact given that the ganglia constitute a kind of "alcabala" that protects the body from any invasion or external agent, it is possible that adenomegaly occurs in situations as trivial as a wedged nail (onychocryptosis).

Now, in order to give a more or less general view of the possible causes of adenomegaly, below is a list of the most common clinical conditions in which the lymph nodes are enlarged:

Viral infections

It is a group of diseases characterized by the formation of granulomas and slow evolution, which affect not only the lymph nodes but also other organs.

Granulomatous diseases can be of infectious origin, such as occurs in tuberculosis, leprosy and some deep mycoses, or of autoimmune origin as is the case of Wegener's granulomatosis.

Response to trauma

This is especially visible in young children where lymph nodes are enlarged in certain areas due to chronic trauma; For example, in children who play soccer, adenomegaly can be seen in the inguinal region due to constant trauma and small injuries to the lower limbs. Likewise, in patients who suffer from extensive burns, it is possible that lymph nodes may develop.

Malignant neoplasms

Adenomegaly itself does not require any treatment, in fact in most cases the lymph nodes will regress (disappear) spontaneously and without leaving any sequelae.

However, when associated symptoms such as fever or pain occur, specific symptomatic treatment may be indicated to alleviate said symptoms; Likewise, once the cause of the adenomegaly is identified, the treatment should be aimed at treating said condition.

In this sense, some patients with adenogalies will not need more than symptomatic treatment (as in the case of reactive lymph nodes secondary to viral diseases), while others will require the use of antibiotics (bacterial infections) and even chemotherapy when it comes to adenomegaly of origin evil one.

References

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