INTRODUCTION:
The cervical lymph node enlargement is the commonest swelling in the neck. Inflammation of cervical lymph nodes are exceedingly common and more so in the developing and underdeveloped countries and presents an enigmatic dilemma considering its varying import and in its management. Underlying its presentation though most of the cases are tuberculosis lymphadenitis or acute reactive hyperplasias, when it occurs in an elderly, one cannot be oblivious to the fact it can always be a secondary carcinomatous deposits.
In this country TB is still rampant and tuberculosis
cervical lymphadenitis is still a common cause, occurring
primarily in children. Absence of co-existing or primary
pulmonary focus but the appearance of matted group of
lymph nodes in the posterior triangle of a child or adult,
who may or may not present with a constitutional
symptoms, though diagnostic but still demands a thorough
investigation. Of all investigations FNAC has emerged as an
important tool that is more confirmative and sensitive. It
being simple and easier to perform needing meager
experience in performing and consuming less time to
perform can be done as an outpatient procedure without
any morbid complications. It needs no preparation for
sampling, but some cases may need more tissue for
examination that may require a tru-cut biopsy or excision
biopsy. FNAC remains the prime mode in differentiating
benign from malignant cause of cervical lymphadenopathy.
In older ages malignant deposits warrants the search
for primaries in upper aero digestive system, occult
primaries in nasopharynx, oropharynx, Hypopharynx and
thyroid etc.
Cervical lymphadenopathy may rarely be a part of
generalized lymphadenopathy like Hodgkin’s lymphoma or
non-Hodgkin’s lymphoma or sarcoidosis etc.
In a myriad of causes ranging from a simple benign
enlargement to a disastorous malignant deposits, cervical
lymphadenopathy cannot be considered as the condition to
be ignored. This study of cervical lymphadenopathy has
been performed in an attempt to define the incidence of
various etiological factors of presentations and to formulate the diagnostic approach and treatment mode in a given
setup and facilities available.
AIM OF THE STUDY:
1. To study the incidence of cervical lymphadenopathy.
2. To analyze the presenting symptoms of different causes of cervical lymphadenopathy.
3. To study the appropriate diagnostic approach and treatment modality of cervical
4. lymphadenopathy.
5. To discuss the conservative and surgical management of cervical lymphadenopathy.
6. To study the commonest secondary metastatic deposit and occult primary in cervical lymph node.
MATERIALS AND METHODS:
All cases included in this study had presented to the
surgical department either as outpatients or as an
inpatients. These patients were studied systematically and
followed carefully based on protocol formatted and the
relevant parameters were noted.
This study was prospective study period of three
years between June 2004 to September 2006.
This patient symptoms, duration of illness, clinical
findings were noted and baseline investigations and
confirmatory diagnostic test were performed.
ENT, upper GI Endoscopy, Bronchoscopy, as
conditions applied were done and treatment modalities
adapted accordingly.
OBSERVATIONS:
1. Incidence for TB lymphadenopathy is high in 21-30 age group.
2. The average age of cervical lymphadenopathy at presentation is 33.83 years.
3. Neck secondaries incidence is high in males.
4. Most common presenting symptom is swelling with or without pain (almost 100%).
5. Most common group of lymph node involved is Upper deep cervical lymph nodes.
6. Slight preponderance for males; F:M:: 62:38.
7. Tuberculous lymph node presented mostly at Stage I. Average duration of symptoms is 24 months and the commonest duration is one month.
CONCLUSION:
Most common cause of cervical lymphadenopathy is tuberculosis.
Most common group of lymph nodes involved is level II which correlates with the literature followed by level V/IV.
Cervical lymphadnopathy occurs with female preponderance including tuberculosis. FNAC is the simplest and most cost effective mode in diagnosing the etiology of cervical lymphadenopathy except lymphoma which required excision to assess the grade of the tumour.
Tuberculous patients were treated with ATT & Modified radical neck dissection for mobile occult primary and palliative RT for advanced neck secondaries.
The most commonest cause for malignant cervical lymph node enlargement is due to naso, oro & hypopharyngeal carcinoma. Thyroid malignancy presented as lateral aberrant thyroid.
Inflammatory breast carcinoma presented with supraclavicular metastasis
