title: Peripheral lymphadenopathy: approach and diagnostic tools.
abstract: Peripheral lymph nodes, located deep in the subcutaneous tissue, clean antigens from the extracellular fluid. Generally, a normal sized lymph node is less than one cm in diameter. Peripheral lymphadenopathy (LAP) is frequently due to a local or systemic, benign, self-limited, infectious disease. However, it could be a manifestation of underlying malignancy. Seventy-five percent of all LAPs are localized, with more than 50% being seen in the head and neck area. LAP may be localized or generalized. Cervical lymph nodes are involved more often than the other lymphatic regions. Generally, it is due to infections, but most of the supraclavicular lymphadenopathies are associated with malignancy. Based on different geographical areas, the etiology is various. For example, in tropical areas, tuberculosis (TB) is a main benign cause of LAP in adults and children. Complete history taking and physical examination are mandatory for diagnosis; however, laboratory tests, imaging diagnostic methods, and tissue samplings are the next steps. Tissue diagnosis by fine needle aspiration biopsy or excisional biopsy is the gold standard evaluation for LAP. 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.
authors.affiliation: Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran;
authors.forename: Shahrzad
authors.initials: S
authors.lastname: Mohseni
authors.affiliation: Research Center for Improvement of Surgical Outcomes and Procedures, Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Abolfazl
authors.initials: A
authors.lastname: Shojaiefard
authors.affiliation: Research Center for Improvement of Surgical Outcomes and Procedures, Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Zhamak
authors.initials: Z
authors.lastname: Khorgami
authors.affiliation: Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran;
authors.forename: Shahriar
authors.initials: S
authors.lastname: Alinejad
authors.affiliation: Research Center for Improvement of Surgical Outcomes and Procedures, Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Ghorbani
authors.affiliation: Research Center for Improvement of Surgical Outcomes and Procedures, Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Ghafouri
keywords: Benign; Diagnosis; Localization; Lymphadenopathy; Malignant
references.citation: Ultrasound Med Biol. 2004 Apr;30(4):441-7
references.pmid: 15121245
references.citation: Ann Afr Med. 2007 Sep;6(3):104-8
references.pmid: 18240497
references.citation: BMJ. 1988 Nov 26;297(6660):1363-8
references.pmid: 3146367
references.citation: Am J Clin Pathol. 2004 Dec;122 Suppl:S87-97
references.pmid: 15690645
references.citation: Pediatr Clin North Am. 2002 Oct;49(5):1009-25
references.pmid: 12430623
references.citation: AJNR Am J Neuroradiol. 2001 Apr;22(4):735-40
references.pmid: 11290489
references.citation: Radiology. 2000 May;215(2):568-73
references.pmid: 10796941
references.citation: J Comput Assist Tomogr. 2005 May-Jun;29(3):369-72
references.pmid: 15891509
references.citation: Br J Surg. 1996 Jan;83(1):75-8
references.pmid: 8653372
references.citation: Semin Oncol. 1993 Dec;20(6):570-82
references.pmid: 8296196
references.citation: Medicine (Baltimore). 2000 Sep;79(5):338-47
references.pmid: 11039082
references.citation: Natl Med J India. 2007 Mar-Apr;20(2):78-80
references.pmid: 17802986
references.citation: Ann Oncol. 2009 May;20 Suppl 4:110-2
references.pmid: 19454426
references.citation: Eur Radiol. 1996;6(4):473-80
references.pmid: 8798027
references.citation: Invest Radiol. 1999 Aug;34(8):509-15
references.pmid: 10434182
references.citation: J Fam Pract. 1988 Oct;27(4):373-6
references.pmid: 3049914
references.citation: J Assoc Physicians India. 2009 Aug;57:585-90
references.pmid: 20209720
references.citation: AJR Am J Roentgenol. 2005 May;184(5):1691-9
references.pmid: 15855141
references.citation: Radiology. 1990 Nov;177(2):379-84
references.pmid: 2217772
references.citation: Eur J Radiol. 1998 Oct;28(3):230-4
references.pmid: 9881258
references.citation: Curr Infect Dis Rep. 2009 May;11(3):183-9
references.pmid: 19366560
references.citation: Diagn Cytopathol. 1996 Dec;15(5):382-6
references.pmid: 8989539
references.citation: Pediatr Surg Int. 2003 Jun;19(4):240-4
references.pmid: 12700919
references.citation: West J Med. 1985 Sep;143(3):393-6
references.pmid: 3840301
references.citation: Semin Respir Crit Care Med. 2007 Feb;28(1):36-52
references.pmid: 17330191
references.citation: West Afr J Med. 2002 Oct-Dec;21(4):319-21
references.pmid: 12665276
references.citation: Clin Radiol. 2003 Feb;58(2):143-7
references.pmid: 12623044
references.citation: Am J Med. 2007 Oct;120(10):911.e1-8
references.pmid: 17904463
references.citation: Hippokratia. 2007 Apr;11(2):67-71
references.pmid: 19582180
references.citation: Br J Radiol. 1995 Mar;68(807):266-70
references.pmid: 7735765
references.citation: Br J Cancer. 2003 Feb 10;88(3):354-61
references.pmid: 12569376
references.citation: J Clin Ultrasound. 1998 Oct;26(8):383-9
references.pmid: 9783244
references.citation: J Pediatr Surg. 1999 Oct;34(10):1447-52
references.pmid: 10549745
references.citation: Clin Infect Dis. 2002 Sep 15;35(6):643-9
references.pmid: 12203159
references.citation: Diagn Cytopathol. 1997 Mar;16(3):200-6
references.pmid: 9099538
references.citation: Eur Radiol. 2007 Mar;17(3):843-9
references.pmid: 17021708
references.citation: Hematology Am Soc Hematol Educ Program. 2009;:523-31
references.pmid: 20008237
references.citation: Cancer. 1999 Jun 1;85(11):2485-90
references.pmid: 10357422
references.citation: Am Fam Physician. 1998 Oct 15;58(6):1313-20
references.pmid: 9803196
references.citation: AJR Am J Roentgenol. 1995 Oct;165(4):981-4
references.pmid: 7677005
references.citation: Clin Infect Dis. 2004 May 15;38(10):1447-53
references.pmid: 15156484
references.citation: Niger Postgrad Med J. 2003 Sep;10(3):165-7
references.pmid: 14692059
references.citation: Cytopathology. 1999 Oct;10(5):291-7
references.pmid: 10588346
references.citation: JAMA. 1984 Sep 14;252(10):1321-6
references.pmid: 6471252
references.citation: N Engl J Med. 2010 May 27;362(21):1993-2000
references.pmid: 20505178
references.citation: J Pak Med Assoc. 2011 Mar;61(3):260-3
references.pmid: 21465941
references.citation: JNMA J Nepal Med Assoc. 2009 Oct-Dec;48(176):306-9
references.pmid: 21105555
references.citation: Indian J Otolaryngol Head Neck Surg. 1997 Oct;49(4):402-5
references.pmid: 23119340
references.citation: Arch Dis Child. 1995 Nov;73(5):476-9
references.pmid: 8554372
references.citation: AJR Am J Roentgenol. 1994 Apr;162(4):965-8
references.pmid: 8141027
references.citation: J Pak Med Assoc. 2006 Sep;56(9):405-8
references.pmid: 17091753
references.citation: Eur J Radiol. 1997 Sep;25(2):152-61
references.pmid: 9283844
references.citation: Eur Arch Otorhinolaryngol. 1994;251(7):404-9
references.pmid: 7857628
references.citation: J Clin Ultrasound. 2007 Jul-Aug;35(6):295-301
references.pmid: 17486566
references.citation: J Ultrasound Med. 2001 May;20(5):533-8
references.pmid: 11345111
references.citation: Radiology. 2002 Jul;224(1):75-81
references.pmid: 12091664
references.citation: Eur J Radiol. 2006 Jun;58(3):345-59
references.pmid: 16480846
references.citation: Br J Radiol. 1979 Jun;52(618):464-7
references.pmid: 465923
references.citation: APMIS. 2005 Jul-Aug;113(7-8):558-63
references.pmid: 16086828
references.citation: World J Surg Oncol. 2011 Feb 28;9:29
references.pmid: 21356049
references.citation: Am J Surg. 1996 Dec;172(6):692-4
references.pmid: 8988680
references.citation: Cytopathology. 2000 Feb;11(1):18-31
references.pmid: 10714372
references.citation: Mayo Clin Proc. 2000 Jul;75(7):723-32
references.pmid: 10907389
references.citation: Swiss Med Wkly. 2010 Feb 20;140(7-8):98-104
references.pmid: 20069473
references.citation: Clin Radiol. 2003 May;58(5):359-66
references.pmid: 12727163
references.citation: Ultrasound Med Biol. 2010 Sep;36(9):1431-6
references.pmid: 20800170
references.citation: J Clin Oncol. 1996 Sep;14(9):2431-4
references.pmid: 8926505
references.citation: AJR Am J Roentgenol. 1997 May;168(5):1311-6
references.pmid: 9129432
references.citation: Ann Oncol. 2010 May;21 Suppl 5:v168-71
references.pmid: 20555072
references.citation: Am J Clin Pathol. 2004 Jun;121 Suppl:S71-80
references.pmid: 15298152
references.citation: Eur Radiol. 2005 Jun;15(6):1215-23
references.pmid: 15690206
references.citation: J Pediatr Surg. 2001 Jan;36(1):7-11
references.pmid: 11150430
references.citation: Clin Infect Dis. 2009 Nov 1;49(9):1350-7
references.pmid: 19793000
references.citation: J Clin Ultrasound. 1997 Feb;25(2):71-6
references.pmid: 9023694
references.citation: Clin Infect Dis. 2001 Aug 15;33(4):570-2
references.pmid: 11462197
references.citation: Radiology. 1998 Jul;208(1):117-23
references.pmid: 9646801
references.citation: Am Fam Physician. 2002 Dec 1;66(11):2103-10
references.pmid: 12484692
references.citation: Haematologica. 1999 Mar;84(3):242-7
references.pmid: 10189390
references.citation: East Afr Med J. 1995 Nov;72(11):703-5
references.pmid: 8904059
references.citation: J Clin Ultrasound. 1989 Feb;17(2):101-6
references.pmid: 2492556
references.citation: Eur Radiol. 2001;11(2):276-83
references.pmid: 11218028
references.citation: Br J Radiol. 2011 Aug;84(1004):727-32
references.pmid: 21427181
references.citation: Med J Malaysia. 2005 Dec;60(5):590-8
references.pmid: 16515110
references.citation: J Clin Oncol. 1996 Sep;14(9):2427-30
references.pmid: 8823320
references.citation: Clin Pediatr (Phila). 1997 Jul;36(7):403-9
references.pmid: 9241478
references.citation: Clin Microbiol Infect. 2004 May;10(5):388-98
references.pmid: 15113314