What is a conglomerate of lymph nodes? Lymphadenopathy and lymphadenitis - enlargement and inflammation of the lymph nodes: causes, diagnosis, treatment

anonymous, Female, 35 years old

Good afternoon, Elena Sergeevna. I am 35 years old. Two years ago a lump appeared in the middle of my neck. They did an ultrasound and said it was a cyst. Several months passed and the cyst disappeared. They did an ultrasound and said it was not a cyst, but that the lymph node was inflamed. They didn’t prescribe anything, they said it would pass. Periodically, the lymph nodes on the neck become inflamed, more often in the spring, and this spring they became inflamed again, there is no pronounced pain to the touch, but when I turn my head, it feels as if I’m pinching it and it hurts. I did an MRI of soft tissues, the conclusion: enlarged submandibular The lymph nodes in the form of conglomerates. On the right, the size of the lymph node conglomerate is 22.4 x 8.7 mm, on the left, 17 x 6.2 mm. A few mental lymph nodes with a diameter of up to 7 mm are identified. The tonsils of the root of the tongue are somewhat hypertrophied, up to 5 mm in diameter. MRI picture shows submandibular, chin, lingual lymphadenopathy. Please tell me how dangerous this is, and what does this even mean, what should I do? If possible, please comment on my question in more detail. I’ll also add that my throat often hurts, but now my throat doesn’t hurt. And I have to talk a lot (this kind of work), i.e. constant stress. Thanks for the answer.)

Thymus cysts

Cysts can be localized in the neck, in the mediastinum, or have a cervical-mediastinal localization.

These are thin-walled single-chamber or multi-chamber formations. They can contain up to 1 - 2 liters of liquid. Most often located in anterior mediastinum, partially in the neck area. Sometimes only in the neck area. The clinic does not have typical features. If they reach large sizes, then they compress neighboring organs, and patients complain of chest pain and shortness of breath. Small cysts may not be clinically apparent.

During X-ray examination pay attention to the localization, change in the shape of the shadow when changing position; when breathing, one can suggest the presence of a thin-walled cyst of the thymus gland.

Lymph nodes of the mediastinum (according to Zhdanov)

I. Group visceral:

1. Paratracheal.

2. Tracheobronchial.

3. Bifurcation.

4. Bronchopulmonary.

5. Mediastinal:

A. front (about mediastinal organs),

B. posterior (on the border of the upper and middle third of the esophagus)

II. Group parietal:

1. Parietal-retrosternal (for breast cancer).

2. Parietal-prevertebral.

3. Parietal-phrenic anterior and posterior.

In systemic diseases, the lymph nodes of the entire visceral group are affected.

Signs of enlarged lymph nodes:

1. Expansion of the mediastinum (can be symmetrical, asymmetrical as in lymphogranulomatosis, more on the right).

2. Polycyclicity of circuits.

3. Backstage symptom.

Diseases that occur with enlarged lymph nodes:

I. Group of diseases - systemic:

· Lymphosarcoma.

· Hodgkin's lymphoma.

· Lymphoadenosis.

(for diseases of the reticuloendothelial system)

· Beck's sarcoidosis.

II. Group. Specific diseases:

· Tuberculous bronchoadenitis.

· Metastases to lymph nodes.

III. Group. Nonspecific diseases:

· Inflammatory hyperplasia of lymph nodes.

IV. Group. Occupational diseases:

· Pneumoconiosis.

Hodgkin's disease (lymphogranulomatosis, malignant granuloma) – large group primary tumors of the lymphatic system (lymphomas), which are local lesions limited to an area or one organ, or are generalized, spreading to the entire lymphatic system, Bone marrow, spleen, liver and other organs. Lymphomas are tumors of the immune system and usually arise from the tissue of the lymph nodes. Lymphomas account for about 4% of all newly diagnosed malignant tumors. Hodgkin's lymphoma accounts for about 40% of all lymphomas. IN Russian Federation The absolute number of patients diagnosed with LM in 2001 was 1607 men and 1603 women.

Hodgkin's disease can affect people of any age, but most often between 20 and 40 years of age. The disease occurs with tumor-like growths of the lymph nodes, is characterized by an undulating course and intoxication, fever, sweating, itching of the skin and gradually increasing cachexia. 65–70% of initially diagnosed patients with Hodgkin lymphoma have damage to the chest organs. The mediastinum is involved in the process in 90% of patients. Isolated mediastinal damage is observed in 25% of patients.

According to the WHO classification of lymphoid neoplasia, there are 4 classic variants of Hodgkin lymphoma:

1. Nodular sclerosis.

2. Classic Hodgkin's disease (rich in lymphocytes).

3. Mixed-cell variant.

4. Lymphoid depletion.

Hodgkin's disease tends to spread to adjacent groups of lymph nodes. The cure rate for patients with Hodgkin's lymphoma is 75–80% for all stages. There is a direct relationship between stage and prognosis. 98% of patients with stages 1 - 2 of LGM without mediastinal involvement have a 5-year survival rate (more than 5 years - 78%), and 88% of patients with damage to the mediastinal lymph nodes have a 5-year survival rate (more than 5 years - 66%). Patients with stage 3 disease have only a 75% 5-year survival rate. Survival from Hodgkin's disease is associated with early and adequate treatment. The main treatment is radiation therapy and chemotherapy treatment.

Primary lymphogranulomatosis of the lung is extremely rare. Lung damage during LGM is usually secondary. It is a consequence of the transition from the lymph nodes of the mediastinum to the lungs. According to A.I. Abrikosov (1947), this transition can occur in different ways:

I. The process spreads from the lymph nodes “by contact” to the lung or generally through the mediastinal pleura.

II. The process can go from the bronchial lymph glands deep into the lung along the bronchi, i.e. peribronchial, sometimes breaks into the bronchus and then intrabronchially. These cases are characterized by growth that goes from the roots deep into the lung along the bronchial tree in the form of strands, forming several nodes of the lobular, confluent type, usually in the lower lobe.

III. Lymphogenic retrograde spread from the roots of the lung and gives nodular forms or diffuse infiltration of the lung tissue.

IV. Hematogenous spread, when miliary dissemination appears in both lungs, reminiscent of miliary pulmonary tuberculosis.

According to L.S. Rosenstrauch distinguishes the following types of lymphogranulomatosis:

1. Mediastinal.

2. Mediastinal-pulmonary.

3. Pulmonary.

4. Mediastinal-pulmonary-pleural.

5. Pleural.

The main methods for diagnosing lung damage in lymphoma are traditional X-ray examination and CT. If there are changes in radiographs, a CT scan is performed to clarify the diagnosis, extent of the lesion and clarify the stage of the process.

X-ray picture. The disease begins with damage to the cervical and subclavian lymph nodes. In the mediastinum, the anterior mediastinal and anterior paratracheal, tracheobronchial lymph nodes are affected. Therefore, the shadow is localized in the upper and middle part of the mediastinum and occupies the upper half of the mediastinum, and also extends to the entire length of the anterior mediastinum. The lesion can be bilateral, less often – unilateral. IN initial stages more often it gives a chain of rounded shadows along the right contour of the trachea. Often there is an isolated lesion of one or two lymph nodes in the mediastinum. The shadow in this case has a regular oval shape, and it is very difficult to differentiate it from other diseases.

A pathological shadow caused by enlarged lymph nodes is usually located in the anterior mediastinum, and the localization of a pathological shadow in the posterior mediastinum is more likely to speak against lymphogranulomatosis. However, when sharp increase lymph nodes, the latter can reach the posterior mediastinum. The nature of the shadow contour is determined by the number of affected lymph nodes and their relationship to neighboring organs. With expansive growth, the contours of the nodes are clear. If enlarged nodes are located at different depths, then the “backstage” symptom appears. If there is a whole conglomerate of mediastinal lymph nodes, then they can push back the mediastinal pleura, and the mediastinum has the appearance of a “pipe”. The trachea and esophagus are displaced posteriorly.

The mediastinal shadow becomes visible on the contour of the tube. This is due to enlarged lymph nodes and tension of the mediastinal pleura. On the contour of the mediastinum there may be polycyclic contours (due to the lymph nodes), the contours may be unclear, stringy - this is due to the germination of the mediastinal pleura, uneven enlargement of the lymph nodes. With enlargement of the paravasal and paratracheal lymph nodes, there is unevenness of the contours of the heart and blood vessels and their expansion. In the lateral projection there is a narrowing and darkening of the retrosternal space, since with lymphogranulomatosis the enlargement of the lymph nodes located in front of the trachea predominates. This is a distinguishing feature from cancer and sarcoidosis. Lymph nodes on tomograms are not differentiated from each other; they merge and form a conglomerate.

Enlarged lymph nodes cause displacement of the esophagus and narrowing of the trachea.

With enlargement of the basal lymph nodes, there may be a paradoxical movement of the dome of the diaphragm and its relaxation.

Often the picture resembles mediastinal cancer - unilateral expansion of the mediastinum. A lateral radiograph helps in diagnosis - enlarged lymph nodes anterior to the trachea. With central cancer, the lymph nodes around the trachea are enlarged and hypoventilation is noted.

Hodgkin's lymphoma can spread to lung tissue. This is most often observed in young people and in children between 7 months and 3 years after detection of enlarged mediastinal lymph nodes. The process is progressing. Spread to lung tissue may be due to ingrowth through the mediastinal pleura. At the same time, on radiographs the shadow of an expanded vascular bundle is visible, which does not have clear boundaries, and in the form of rough strands, transversely located and growing into the lung tissue. These strands narrow towards the periphery and are lost against the background of the transparent lung. Strands and linear shadows also extend from the roots of the lungs, which are a reflection of lymphogranulomatous muffs covering the bronchi and vessels.

In the lungs, rounded shadows of 3–5 cm with clear and fuzzy contours appear - granulomas. They can long time maintain clear contours and resemble metastases. But unlike metastases, there are few of them, they are located far from each other, the lesion can be unilateral or bilateral. Shadows can merge into large infiltrates, which are complicated by decay. There may be small focal shadows located in the lower parts of the lungs against the background of dense interstitial tissue and resemble miliary carcinomatosis.

Large infiltrates may occur in the lungs. The granuloma grows into the alveoli with the organization of fibrous effusion, and resembles pneumonia. May occupy a segment or share. The contours of the shadow are often unclear. Single nodular formations of lymphogranulomatosis can be localized in any part of the lung, and if there are no enlarged lymph nodes in the root and mediastinum, it is difficult to make a diagnosis, and a diagnosis is made peripheral cancer.

Often, along with changes in the lungs, inexhaustible effusion appears in the pleural cavity. Sometimes dry pleurisy is observed, which leads to complete obliteration of the pleural cavity.

The isolated pleural form of lymphogranulomatosis is rare. It manifests itself as thickening of the pleura and accumulation of exudate.

Complications of Hodgkin's lymphoma

1. Atelectasis as a result of compression and germination of the walls of the bronchi.

2. Decay – in the terminal stage.

3. Pneumonia.

4. Esophageal-bronchial fistulas.

IN medical practice The following ways of spreading malignant neoplasms are known:

• lymphogenous;
• hematogenous;
• mixed.

Lymphogenic metastasis is characterized by the penetration of tumor cells into the lymphatic vessel and then through the flow of lymph to nearby or distant lymph nodes. Epithelial cancers (eg, melanoma) are more likely to spread through the lymphatic route. Tumor processes in internal organs: stomach, colon, larynx, uterus - thus capable of creating metastases in the lymph nodes.

The hematogenous route includes the spread of tumor processes using blood flow from the affected organ to the healthy one. Moreover, the lymphogenous route leads to regional (close to the affected organ) metastases, and the hematogenous route promotes the spread of affected cells to distant organs. Lymphogenic metastasis has been well studied, which makes it possible to recognize most tumors at their inception stages and provide timely medical care.

In the neck area, the lymph nodes form a collector that accumulates lymph coming from the organs of the head, sternum, upper limbs, as well as from the peritoneum, torso and legs. Doctors have established a pattern between the path of metastasis and the course of the lymphatic bed. In this regard, metastases in the lymph nodes located at the level of the chin and under the jaw are detected in tumor processes of the lower lip, anterior part of the tongue and oral cavity, upper jaw. Metastases of malignant neoplasms of the posterior parts of the tongue, floor of the mouth, thyroid gland, areas of the pharynx and larynx spread to the lymph nodes of the neck area, namely to the area of ​​the carotid neurovascular bundle. Metastases in the lymph nodes of the area above the collarbone (outside the sternocleidomastoid muscle) often develop with breast or lung cancer. Malignant neoplasms of the peritoneal region metastasize to the lymph nodes above the collarbone (inside the sternocleidomastoid muscle). Inguinal lymph nodes contain cancer metastases lower limbs, areas of the sacrum and buttocks, as well as the external genitalia.

Metastasis is understood as a secondary pathological lesion of cells growing in tissues human body from the site of the primary disease.

The function of the lymphatic system is to maintain metabolic processes, as well as cleansing (filtering) at the cellular level, as a complement to the cardiovascular system. Lymph nodes are grouped according to their location in the human body and serve to produce lymphocytes - immune cells, fighting harmful foreign microorganisms that penetrate the body.

Reasons influencing the development of metastases:

• age factor (metastases appear more often at older ages);
• development concomitant diseases(chronic, weakening the body’s defenses);
• the size and localization of the initial focus of the malignant neoplasm (the presence of a large tumor increases the possibility of metastases);
• spread of tumor cells (the growth of malignant tumors into the wall of an organ is most dangerous and more often causes metastasis than neoplasms growing into the lumen of the organ).

Symptoms of metastases in the lymph nodes

The International Classification of Malignant Tumors defines metastases in lymph nodes using the Latin letter N. The stage of the disease is described by the number of metastases, and not the size of the affected tissue. N-0 indicates the absence of metastases, N-1 means a single metastasis of nodes close to the tumor, N-2 means a large number of metastases of regional lymph nodes. The designation N-3 means simultaneous damage to nearby and distant lymph nodes, which is inherent in the fourth stage of the tumor process.

The primary symptoms of metastases in the lymph nodes are a significant increase in size, which is determined by visual examination and palpation. Most often, changes are differentiated in the cervical, supraclavicular, axillary and inguinal lymph nodes, which have a soft-elastic structure and are painless.

The growth of lymph nodes in size is often accompanied by weight loss, and the patient’s condition is characterized by general weakness and anemia. Warning signs also include temperature, frequent colds, neuroses, enlarged liver, migraines, redness of the skin. The appearance of metastases indicates the progression of the malignant neoplasm. If you independently detect lymphadenopathy (enlarged lymph node), you should consult a specialist without self-medicating.

It is important to note that often metastases in the lymph nodes are recognized earlier than the source of the problem - a malignant tumor.

Metastases in the lymph nodes of the neck

Tumors of the neck area are united into a small but quite diverse group in terms of clinical manifestations. Neoplasms are observed both in the organ itself (larynx, pharynx, esophagus, thyroid etc.), and in soft tissues necks not related to the organ.

The main lymphatic collector is located on the neck, and the formation of metastases in its nodes occurs due to damage to lymphoreticular tissue, as a result of lymphogranulomatosis, hematosarcoma, lymphosarcoma, metastasis of malignant tumors (Virchow's metastasis).

Metastases in the lymph nodes of the neck lead to changes in the shape, size, structure and echogenicity of the nodes. Lymphogranulomatosis most often (60% of cases) occurs with metastases to the nodes of the neck. In this case, pathological processes can be observed in the axillary, inguinal, mediastinal, as well as lymph nodes of the retroperitoneal zone. There are cases of simultaneous damage to the thyroid gland and lymph nodes of the neck, which is clinically similar to thyroid cancer with metastasis to the cervical nodes.

Lymphogranulomatosis is more common in 20-30 year old patients or people over 60 years old (usually male). Primary manifestation The disease is an enlargement of a lymph node or a group of nodes with an elastic consistency. Further, the fusion of lymph nodes of various densities and sizes into a single conglomerate is noted. Patients complain of: general weakness, sweating, itching of the skin, fever and lack of appetite. The clinical picture varies depending on the individual course and stage of the disease, so the described symptoms may be vague or completely absent.

Metastases in the lymph nodes are often detected in lymphosarcoma. The nodes are enlarged and have a dense structure, and the speed internal changes of the affected conglomerate can cause compression of adjacent organs within a couple of weeks. During the examination, the patient may be diagnosed with growth of inguinal and axillary nodes.

Along with malignant tumors of the head and neck ( tumor processes language, salivary glands, thyroid gland, larynx) metastases in the lymph nodes of the neck are detected in breast cancer, damage to the lungs or organs abdominal cavity, which indicates the fourth stage of the disease.

About 30% of cases of primary tumor processes remain undifferentiated. To examine a patient for the presence of cancer of the neck, diagnostics using anesthesia is used. Thyroid cancer can take hidden form, manifesting itself only as metastases to the cervical lymph nodes. The palpation method and ultrasound do not always reveal dense neoplasms, therefore puncture and excisional biopsies are widely used.

Metastases to cervical lymph nodes

Damage to the cervical lymph nodes - metastases to the cervical lymph nodes are characterized by general symptoms:

• significant growth of nodes;
• change in shape (contours are uneven, unclear);
• anechoic areas are noted.

An ultrasound examination reveals a violation of the ratio of the transverse and longitudinal size of the node or a difference (less than 1.5) between the long and short axes. In other words, if the lymph node acquires a round shape, then there is a high probability of its damage.

Cancer processes in the lymph nodes increase the fluid content in them. An ultrasound scan shows a blurred outline of the node. The lymph node capsule is still recognizable at an early stage of the disease. As malignant cells grow, the contours are erased, the tumor grows into nearby tissues, and it is also possible for several affected lymph nodes to fuse into a single conglomerate.

Metastases to the cervical lymph nodes are formed from lymphomas, cancers of the lung, gastrointestinal tract, prostate or breast. Most often, when metastases are detected in the lymph nodes of the neck, the localization is primary tumor– upper parts of the respiratory or digestive system.

Enlargement of the lymph nodes in the neck area occurs with the following oncological diseases:

• cancer processes of the larynx, tongue, oral mucosa;
• damage to the thyroid gland;

Diagnosis is made by puncture or excisional biopsy. Treatment methods include irradiation and surgical removal of the affected node.

Metastases in the lymph nodes in the groin

The lymph nodes of the groin area retain and destroy pathogenic microorganisms that penetrate the lymphatic system from the pelvic organs (usually the genital area) and lower extremities. Primary malignant neoplasms or lymphomas can form in the inguinal lymph nodes themselves.

Inguinal lymph nodes are divided into deep and superficial. The latter are located in the area of ​​the so-called “femoral triangle” and on the surface of the lata fascia of the thigh, their number varies from four to twenty pieces. The inguinal nodes communicate with the tissues of the lower extremities, the perineal area, and the anterior wall of the peritoneum below the navel. The number of deep lymph nodes in the groin ranges from one to seven. Their location is under the surface of the plate of the fascia lata of the thigh. These nodes are interconnected with lymphatic vessels located on the surface groin area and deep in the femoral area.

A painless symptom with a characteristic increase in node size may indicate metastases in the lymph nodes in the groin. The growth of inguinal lymph nodes occurs in the following oncological diseases:

• lumbar melanoma or skin cancer of the lower extremities;
• malignant neoplasm in the rectum;
• genital cancer;
• lymphogranulomatosis (Hodgkin's lymphoma).

Cases of damage to the inguinal nodes require a thorough examination of the skin of the legs, as well as organs located in the pelvis and peritoneal cavity. For diagnostic purposes the following is used: computed tomography(CT), colonoscopy, cystoscopy, hysteroscopy, FEGDS.

Metastases to inguinal lymph nodes

The lymph nodes of the inguinal zone pass lymph coming from the genitals, the lower rectum and abdominal wall, and the lower extremities. Based on their location, nodes are divided into superficial and deep.

Malignant neoplasms of the legs, sacro-gluteal area, and external genitalia form metastases to the inguinal lymph nodes. Lymph nodes take on the appearance of rounded compactions in the area of ​​the inguinal folds. The nodes are tightly fused to nearby tissues and are inactive, which is observed when trying to move them.

Types of cancer that cause enlarged lymph nodes in the groin:

• melanoma or cancer of the skin of the legs (lumbar area);
• rectal oncology;
• malignant formations of the genital area;
• Hodgkin's lymphoma (lymphogranulomatosis).

The initial development of lymphogranulomatosis with damage to the lymph nodes in the groin is quite rare (10%). The disease is characterized by weight loss, an unreasonable rise in temperature, and excessive sweating at night.

During the examination, the doctor examines the lymph nodes by palpation, first along and then across the groin fold, using sliding circular movements, and moves to the area of ​​the lata fascia of the thigh.

Metastases to retroperitoneal lymph nodes

The retroperitoneal space is the area of ​​the abdomen behind the peritoneal wall, bounded by the peritoneum, back muscles, sacrum, diaphragm and lateral abdominal walls. The lymphatic system of the retroperitoneum includes regional lymph nodes, vessels and large lymph collectors, from which the thoracic lymphatic duct originates.

Localization of malignant neoplasms in the peritoneal area has the following symptoms: increased temperature, cramping pain in the abdomen (appears in paroxysms), stool disorder in the form of diarrhea (less commonly, constipation). Metastases to the retroperitoneal lymph nodes are observed in germ cell tumor processes in the testicle, kidney, cancer diseases gastrointestinal tract. Enlargement of the retroperitoneal lymph nodes leads to severe pain in the back due to compression of the nerve roots, sometimes affecting the lumbar muscle. Gastrointestinal symptoms are common, and sudden weight loss is observed.

The condition of the lymph nodes and organs of the retroperitoneal space is assessed based on the results ultrasound examination, computed and magnetic resonance imaging. An ultrasound scan shows nodes with metastases as round or oblong, characterized by clear contours and uniformity of structure. The CT method determines metastases in the lymph nodes by their round shape and soft tissue structure. The affected lymph nodes of the retroperitoneal cavity have a uniform structure and density, as well as clear contours, and can merge into large conglomerates. In the case when the lymph node arrays cover the spine, the aorta in the peritoneal zone and the inferior vena cava, intravenous contrast is used to better recognize tumor processes.

Metastases to para-aortic lymph nodes

Location of para-aortic lymph nodes - anterior part lumbar region spine, along the aorta.

Metastases to the para-aortic lymph nodes are observed in patients with cancer of the genital area, kidneys and adrenal glands, and gastrointestinal tract. For example, with malignant neoplasms of the stomach, in 40% of cases, affected para-aortic lymph nodes are detected. Tumor processes with metastasis to the para-aortic lymph nodes are classified as the third or fourth stages of the disease. Moreover, the frequency of damage to para-aortic nodes of the third degree of oncology reaches 41%, and the fourth degree – 67%. It should be noted that, for example, metastases to para-aortic lymph nodes of ovarian cancer are resistant to chemotherapy.

The development of pancreatic cancer has its own stages of lymphogenous metastasis:

• first stage - metastases reach the head of the pancreas;
• second stage – retropyloric and hepatoduodenal lymph nodes are affected;
• third stage - penetration of metastases into the celiac and superior mesenteric nodes;
• the fourth stage is metastasis to the para-aortic lymph nodes.

Doctors note that malignant tumors of the pancreas are characterized by an aggressive course and have a poor prognosis. Deaths from pancreatic cancer rank 4th-5th among all oncological diseases. High mortality is associated with recurrence of tumor processes in postoperative period(K-ras mutations in para-aortic lymph nodes).

Metastases in the lymph nodes of the abdominal cavity

A large number of lymph nodes are located in the abdominal cavity, representing a barrier to infection and cancer cells. Lymph nodes of the peritoneum are divided into parietal (concentrated in the lumbar area) and intramural (located in rows).

Damage to the peritoneal lymph nodes is the result of a lymphoproliferative disease (the primary tumor forms in the lymph node itself) or a consequence of metastasis. Lymphogranulomatosis and lymphosarcoma are lymphoproliferative diseases that cause compaction and growth in the size of the node without pain syndrome. Metastases in the lymph nodes of the abdominal cavity are detected in a number of cancers, when tumor cells penetrate into the lymph nodes from the affected organ with the lymph flow. Thus, malignant tumors of the peritoneal organs (for example, the stomach) and the pelvis (for example, the ovary) cause the formation of metastases in the peritoneal lymph nodes.

The main criterion confirming the presence of metastases in the lymph nodes is an increase in size of the node (up to 10 cm or more). CT and MRI studies of the peritoneal cavity also come to the rescue in order to obtain visualization of anatomical structures.

Melanoma metastases to lymph nodes

Melanoma is a rare malignant tumor that most often affects residents of the southern regions. It should be noted that in 70% of cases, melanoma is formed at the site of an existing pigmented nevus or birthmark.

The development of melanomas occurs in two phases:

• horizontal – growth within the epithelial layer (lasts from 7 to 20 years);
• vertical - ingrowth of layers of the epidermis and subsequent invasion through the basement membrane into the dermis and subcutaneous fatty tissue.

The vertical stage is distinguished by its rapidity and ability to metastasize. Metastases of melanoma to lymph nodes are determined primarily by the biological characteristics of the tumor. Lymphogenous metastasis occurs in skin, regional lymph nodes. The affected lymph nodes become dense in consistency and increase in size.

Among the diagnostic methods are aspiration biopsy education, surgical biopsy of lymph nodes, radiography, CT and MRI of the whole body. Removal of melanoma metastases to the lymph nodes is carried out by complete excision of the regional lymph node or removal of lymph nodes close to the tumor (if the diagnosis is made on the basis of a biopsy).

Metastases to supraclavicular lymph nodes

Metastases to the supraclavicular lymph nodes occur when:

• undifferentiated cancer (the primary tumor is located in the neck or head);
• tumor processes in the lungs;
• cancer of the gastrointestinal tract.

Identification of Virchow's (Troisier's) nodes in the left supraclavicular region indicates the presence of a malignant neoplasm of the abdominal cavity. Damage to the supraclavicular nodes on the right side makes it possible to suspect lung or prostate cancer. Metastases in the lymph nodes of the subclavian triangle may indicate lung or breast cancer.

One of the most common tumors, gastric cancer, is diagnosed by identifying “Virchow metastases” (usually in the left supraclavicular lymph nodes). Malignant ovarian cells sometimes penetrate through the lymphatic vessels of the diaphragm and lumbar lymph nodes, which causes lymphatic metastasis above the diaphragm - metastases to the supraclavicular lymph nodes.

Enlargement of supraclavicular nodes – alarming symptom, most often meaning tumor processes in the sternum or abdominal area. In 90% of cases, similar symptoms occur in patients over 40 years of age, the proportion of patients younger age accounts for 25% of cases. Damage to the lymph nodes on the right corresponds to a tumor of the mediastinum, lungs, and esophagus. An increase in the size of nodes on the left in the supraclavicular zone indicates cancer of the ovaries, testes, prostate, bladder, kidneys, stomach, pancreas.

Metastases in the mediastinal lymph nodes

The mediastinum is a section of the thoracic cavity, which is limited in front by the sternum, costal cartilages and substernal fascia, and behind by the anterior zone. thoracic spine, neck of the ribs, prevertebral fascia, on the sides - layers of the mediastinal pleura. The mediastinum area is indicated below by the diaphragm, and above by a conventional horizontal line. The mediastinal zone includes the thoracic lymph duct, retrosternal lymph nodes, and anterior mediastinal lymph nodes.

In addition to lung cancer, metastases in the lymph nodes of the mediastinum form tumor processes of the thyroid gland and esophagus, kidney hypernephroma, testicular cancer (seminoma), pigmented malignancy (melanosarcoma), uterine cancer (chorionepithelioma) and other neoplasms. Damage to the mediastinal lymph nodes ranks third in the development of malignant processes after lymphogranulomatosis and lymphosarcoma. Cancer cells cover all groups of mediastinal lymph nodes, the paratracheal and bifurcation ones are most often affected.

Small primary tumors often give extensive metastases to the mediastinal lymph nodes. A striking example Similar metastasis is lung cancer of the mediastinal form. IN clinical picture swelling of the soft tissues of the neck and head, swelling and interweaving of the veins in the front of the chest (“jellyfish head”) are described, dysphagia, hoarseness, and stridor-type breathing are noted. X-ray in most cases reveals the predominance of metastases in the posterior mediastinum.

In breast cancer, the accumulation of affected lymph nodes is localized in the anterior mediastinum. For the clarification method, mammariography (contrast study of the veins of the mammary glands) is used. Interruption of the venous bed, compression, and the presence of marginal defects serve as evidence of the presence of metastases that require removal or treatment through radiation.

Treatment of metastases in lymph nodes

The main rule of oncology is to study the condition of the lymph nodes, both in the tumor zone itself and in remote ones. This allows you to most accurately establish a diagnosis and prescribe effective program treatment.

Lying lymph nodes that are accessible to external inspection are examined by biopsy and puncture. The condition of deeper lymph nodes is examined using ultrasound, CT, and MRI. The most precise method Positron emission tomography (PET) is considered to be used to detect metastases in lymph nodes, thanks to which it is possible to recognize the origin of malignant cells in the most inaccessible and slightly enlarged lymph nodes.

Treatment of metastases in lymph nodes is based on the same principles as the fight against a primary cancer tumor - surgery, chemotherapy, radiotherapy. A combination of these techniques is used individually, depending on the stage of the disease (malignancy) and the degree of damage to the lymphatic system.

Excision of the primary tumor is usually accompanied by removal of all its regional lymph nodes (lymphadenectomy). Lymph nodes with damaged cells located further than the cancerous tumor are treated with radiotherapy or bloodless radiosurgery is performed using a cyberknife.

Timely diagnosis and treatment of metastases in the lymph nodes makes it possible to block the proliferation of tumor cells and prolong the patient’s life.

Prognosis of metastases in lymph nodes

Factors influencing patient survival are conventionally divided into related:

• with a cancerous tumor;
• with the patient’s body;
• with the treatment provided.

The most important prognostic factor is damage to regional lymph nodes without the presence of distant metastases. For example, the prognosis for metastases in the lymph nodes of the neck of “non-squamous cell carcinoma” remains disappointing – 10-25 months. The survival of patients with stomach cancer depends on the possibility of radical surgery. Only small part non-operated or non-radically operated patients reaches the five-year mark. Average duration life is 3-11 months, and this figure is influenced by the presence or absence of distant metastases.

The presence of metastases in the lymph nodes in breast cancer significantly worsens the prognosis. As a rule, relapses and metastasis are observed in the first five years after surgical intervention in 35-65% of women, which indicates an activation of the process. Life expectancy after treatment is 12-24 months.

Patients with melanoma of the head, neck, and trunk have a more unfavorable prognosis than those with melanoma of the extremities, since the risk of metastasis to the lymph nodes of these tumors is 35% higher.

criterion successful treatment may serve as a five-year survival rate. The prognosis after tumor excision is determined not only by the presence or absence of metastases in regional lymph nodes, but also by the number of affected nodes.

If metastases are found in lymph nodes without a primary tumor site, the prognosis may be favorable. The outcome of special treatment based on the five-year survival rate for isolated lymph node metastasis is: in case of lesion axillary lymph nodes– more than 64%, inguinal – over 63%, cervical – 48%.

It is important to know!

Damage to peripheral lymph nodes is most often caused by mycobacteria bullish type. This must be taken into account when making a diagnosis in certain regions of Russia, especially in rural areas. Many authors associate the development of a specific process in the lymph nodes with the lymphotropic nature of MVT and barrier function lymph nodes rich in elements of the mononuclear phagocyte system, in which initial reactive (and then specific) changes most often occur.

A conglomerate of lymph nodes is a large tumor-like formation that forms when they merge. The appearance is characteristic of cancerous tumors, but it can also be triggered by inflammatory processes that develop as a result of sarcoidosis or infectious disease. In addition to merging with each other, lymph nodes can adhere to nearby tissues.

Adhesive lymph nodes arise as a result of various pathological processes in the body. First of all, when differential diagnosis It is necessary to exclude systemic diseases of the nodes and tuberculosis. Conglomerates of mediastinal lymph nodes are often found in people who have had tuberculosis in early childhood.

The main factors of hypertrophy and fusion of nodes are:

• bacterial infections (tonsillitis, caries, otitis media, frontal sinusitis);
• viral diseases (chickenpox, mononucleosis, herpes, hepatitis, felinosis, HIV);
• rheumatoid pathologies;
• blood diseases;
• chronic alcoholism;
• helminthiases;
• allergic reactions;
• pathologies of the endocrine system;
• neoplasms and their metastases;
• pyoderma.

A serious disease in which conglomerates form is lymphogranulomatosis (cancer of the lymphatic and circulatory system). At the same time, the nodes increase and are soldered, attached general symptoms intoxication (hyperthermia, weakness, sweating).

Symptoms of lymph node conglomeration

Signs of pathology depend on the disease that led to the enlargement of the lymph nodes. Basically, you can see the following picture:

• lymph nodes enlarge and are more than 1 cm in size;
• contours become uneven;
• fused lymph nodes form a package;
• change consistency (compact) and become heterogeneous in structure.

The conglomerate of lymph nodes has similar Clinical signs from different regional groups. Tuberculosis lesions are characterized by an increase in one group of nodes at the beginning of the disease, with time pathological process generalized. In this disease, the signs of conglomerate include general weakness and fatigue, intoxication phenomena, sleep disturbances, hyperthermia, weight loss, pale skin, and night sweats.

Diagnostics

FORMATION of a conglomerate of lymph nodes and hilar infiltrate. Photo taken from the medical site present5.com

Conglomeration of lymph nodes can occur when various diseases. To select the correct treatment regimen, it is necessary to undergo laboratory and instrumental examination.

Informative following methods diagnostics:

1. X-ray of the chest organs.
2. CT scan. In case of lymph node hypertrophy, it is a valuable research method that allows one to assess the degree of adhesion to tissues, the structure of the node, the absence or presence of oncological pathology.
3. A biopsy is resorted to when there is a diagnostic difficulty, suspicion of cancerous degeneration of the process, or lack of proper treatment results.
4. Ultrasound allows you to record hypertrophy of the lymph nodes of the abdominal cavity (for gastrointestinal pathologies, lymphoma).

During the appointment, the doctor examines the patient, evaluates general state health, the size and location of the conglomerate, ascertains additional clinical signs and collects anamnesis.

A general blood test significantly complements the diagnosis. An increase in the number of leukocytes can indicate the presence of an inflammatory process. An increase in the number of lymphocytes indicates the viral nature of the disease. The presence of atypical mononuclear cells in the biomaterial indicates mononucleosis, and the appearance of blast cells indicates acute leukemia.

Treatment

If there is a suspicion that the lymph nodes are enlarged and fused together, then you need to visit your local physician. The doctor will examine and collect anamnesis, after which he will refer you for consultation to a specialist (phthisiatrician, infectious disease specialist, oncologist).

You should not hesitate to visit a doctor, much less use unconventional methods of treatment, especially heating the affected areas. Conglomeration of lymph nodes is a symptom of many serious illnesses, for example, lymphogranulomatosis or tuberculosis.

Diagnosis of infectious diseases includes examination and laboratory research. During the examination and interview of the patient, the infectious disease specialist evaluates the patient’s symptoms and finds out his contacts with contagious patients. Therapy takes place in isolation and includes antibacterial and antivirals, depending on the type of infection. The duration of therapy in this case is about 2-4 weeks.

If the presence of a cancerous tumor and metastases is suspected, the oncologist determines the location and size of the tumor, and the stage of development. The treatment method and prognosis depend on these indicators. The classic treatment regimen for cancer tumors includes surgical excision of the affected area followed by radiation and chemotherapy.

… an increase in lymph nodes indicates trouble in the area that the node “serves”.

General information. Lymph node examination is an important part of the overall clinical examination. A methodical search for enlarged lymph nodes can provide valuable information about malignant neoplasm And systemic disease.

L/s are formations of round, oval, bean-shaped, less often ribbon-shaped, ranging in size from 0.5 to 50 mm or more. L/s are painted pinkish-gray and are located along the lymphatic vessels, as a rule, in clusters of up to ten pieces, near blood vessels, more often - near large veins. The surface of the lymph node is covered with a connective tissue capsule, from which trabeculae extend into the node - beams, also formed by connective tissue. They are supporting structures. The stroma, the basis of the lymph node, is formed by reticular connective tissue, the process cells of which and the reticular fibers formed by them form a three-dimensional network. The stroma also includes phagocytic cells - macrophages, which are represented in the lymph nodes in several varieties. Inflowing lymph brings foreign antigens into the lymph node, which leads to the development of immune response reactions in the lymph node and an increase in the size of the lymph node. L\u is a barrier to the spread of both infection and cancer cells. It also produces lymphocytes - protective cells that actively participate in the destruction of foreign substances and cells.

Characteristics of lymph nodes assessed by palpation:

Size: size can be easily determined using a plastic ruler; clinically significant, with a certain degree of probability indicating a pathological process, an increase in lymph nodes > 1 cm is recognized; however, there are exceptions to this rule: for example, anterior ear< 1 см часто свидетельствуют о патологии и, наоборот, значительно увеличенные л/у доброкачественной природы часто обнаруживаются у лиц, принимающих наркотики внутривенно; увеличение л/у >5 cm is almost always due to a neoplasm;

Consistency: the rocky density of l/u is usually due to their involvement in the malignant process, but there are exceptions, for example, with Hodgkin's disease, l/u are most often of rubber density; fluctuating lymph nodes reflect necrosis or bacterial lymphadenitis; they can open on the skin, forming fistulas (typical of tuberculosis), lymph nodes of this type are often called buboes, especially if they are localized in the groin; sometimes l/s are palpated, giving the sensation of large shot or peas, most often they are small, similar (but not the same) in size in different patients, hard, but not rocky in density, mobile, painless on palpation and clearly demarcated;

formation of conglomerates: with the merging and formation of conglomerates, individual lymph nodes are transformed into large tumor-like formations; the formation of lymph conglomerates is characteristic of malignant neoplasms, but it can also be caused by inflammatory processes, for example, chronic infections or sarcoidosis; in addition to fusion, lymph nodes can be fused to the skin or subcutaneous tissues;

pain on palpation: tenderness to palpation is an important clinical characteristic, usually caused by inflammation, but sometimes also by malignant tumors; with tuberculosis, lymph nodes can be either painful or painless.

On a note: lymph nodes in benign diseases are characterized by small size, soft consistency, painlessness on palpation, good limitation; l / in malignant neoplasms are large, rocky in density, painless on palpation, form conglomerates; l / u with inflammation, painful on palpation, hard (but not rocky), occasionally fluctuate and often form conglomerates.

Features of lymph nodes taken into account when assessing their clinical significance. Important has localization l/u. For example, the clinical significance of palpable anterior ear lymph nodes of any size is higher than the same size lymph nodes in any other area. It is very important to distinguish between generalized and regional lymphadenopathy, which are caused by two different groups of pathological processes and imply a different differential diagnosis algorithm:

causes of generalized lymphadenopathy: disseminated malignant tumors, especially hematological (lymphomas, leukemia); diseases connective tissue(including sarcoidosis); infections ( Infectious mononucleosis, syphilis, cytomegalovirus infection, toxoplasmosis, rheumatism, AIDS, tuberculosis and, of course, Bubonic plague previous years); other, including drug reactions (for example, to phenytoin), intravenous administration drugs;

regional lymphadenopathy, as a rule, is caused by either a local infection or a neoplasm.

Areas to be palpated to identify lymph nodes. You should try to palpate the left armpits, in the area of ​​the epicondyles, on the head and neck, in the supraclavicular fossae, in the groin and on the anterior surface of the thigh. Enlarged lymph nodes of clinical significance can be found in the popliteal fossa and periumbilical region.

Clinical significance of enlarged axillary lymph nodes. Normally, axillary lymph nodes are not palpable, although small, mobile, soft, painless lymph nodes on palpation can be found in healthy people. Larger, more mobile, painful on palpation lymph nodes are found with small wounds and infectious processes on the arm (disease cat scratch, skin infections). More dense, immobile lymph nodes forming conglomerates most often indicate metastases (usually lung cancer or mammary gland).

To identify axillary lymph nodes deep palpation of the axillary fossa and its apex is carried out using the fingertips. First, this manipulation is performed when the patient’s arm is relaxed and passively abducted from the chest, then it is repeated when the arm is passively abducted towards the chest.

Clinical significance of enlarged lymph nodes of the head and neck. Clinical significance depends on location:

enlargement of the occipital l/s located at the border of the head and neck, typical for childhood infections; in adults, the occipital lymph nodes rarely increase, unless obvious signs scalp infections; in the absence of infection, enlargement of the occipital lymph nodes usually indicates generalized lymphadenopathy, for example, with HIV infection;

enlargement of posterior cervical lymph nodes happens with dandruff;

enlargement of the anterior ear lobes detected in lymphomas, as well as in conjunctivitis on the ipsilateral side (the latter phenomenon is called Parinaud's syndrome in honor of Henri Parinaud, one of the founding fathers of French ophthalmology);

enlargement of lymph nodes located near both branches of the lower jaw(i.e. submandibular and submental) most often reflects a local pathological process (usually periodontitis or other dental infections) rather than metastasis of malignant tumors from organs outside the head and neck.

Palpation of the rocky density of the upper posterior cervical lymph nodes may suggest a tumor of the nasopharynx; mental and mandibular lymph nodes - swelling of the nose, lip, anterior part of the tongue or anterior part of the floor of the oral cavity; medium deep cervical lymph nodes - tumor of the base of the tongue or larynx; lower deep cervical lymph nodes – primary thyroid cancer or cervical region esophagus.

Clinical significance of l/n of the head and neck, resembling large shot on palpation. L/s of this type are small, the size of a pea, painless on palpation, mobile, well demarcated. They are very common, especially in young children, and in most cases reflect a previous infection. Once cured, they persist for several weeks. Their location reflects the localization infectious process: anterior cervical l / u - infections of the upper respiratory tract and the anterior part of the oral cavity; posterior cervical l/u – otitis media and scalp infections.

Delphic l/u. Delphic lymph nodes are a group of small, mid-located preglottic lymph nodes lying on the cricothyroid membrane. they are called Delphic because of their high prognostic significance (in ancient Greece a famous soothsayer was the oracle from the city of Delphi). An increase in these lymph nodes occurs with diseases of the thyroid gland (subacute thyroiditis, Hashimoto's disease, thyroid cancer), as well as with tracheal cancer. The Delphic nodes should not be confused with the pyramidal lobe of the thyroid gland.

Clinical significance of enlarged supraclavicular lymph nodes. The finding of an enlarged lymph node in the right or left supraclavicular fossa is an important finding, most often indicating cancer of the ipsilateral lung or breast. However, it should be noted that an increase in lymph nodes in the right supraclavicular fossa can be observed in cancer of the lower lobe of the left lung due to cross lymphatic drainage. An increase in the supraclavicular lymph node in the left supraclavicular fossa may be due to metastasis of various malignant tumors emanating from the abdominal and pelvic organs. ( ! ) A large left supraclavicular lymph node is often called a sentinel node (warning of a distant malignant tumor) or Troisier's node (in honor of a professor at the University of Paris who lived from 1844 to 1919 and studied the spread of malignant tumors along the lymphatic tract).

Troisier knot- This is a single lymph node in the left supraclavicular fossa, often located behind the clavicular head of the sternocleidomastoid muscle. Trauzier's node can occur due to metastasis of cancer of the ipsilateral lung, breast, and esophagus. Most often, however, Trauzier's node is caused by the metastatic spread of tumors originating from the abdominal and pelvic organs - the stomach, intestines, liver, kidneys, pancreas, testicles and endometrium. When this node is caused by metastasis in stomach cancer, it is called Virchow's gland or Virchow's node (in honor of Rudolf L. K. Virchow, who lived from 1821 to 1902).

Method of palpation of supraclavicular lymph nodes. The patient sits and looks straight ahead, his arms are lowered (which reduces the risk of being mistaken for a cervical vertebrae and muscles). The doctor is behind the patient’s back - and this position is more convenient to palpate the supraclavicular fossa. Palpation is also carried out in the supine position, when, due to the influence of gravity, the lymph nodes become more mobile, which increases the chance of detecting them. Finally, having the patient perform a Valsalva maneuver or even just coughing can move deep-lying lymph nodes closer to the surface of the skin, allowing them to reach the doctor's fingers.

Clinical significance of enlarged supracondylar (ulnar) lymph nodes. Enlargement of the supracondylar lymph nodes occurs when inflammatory process in the hand or forearm. These l/s may be increased in individuals who abuse narcotic drugs(with intravenous use), as well as with sarcoidosis.

Method of palpation of supracondylar lymph nodes. The doctor shakes with his right hand right hand the patient, at the same time palpates the area of ​​the epicondyles with the tips of his left hand. The examination of the supracondylar lymph nodes on the left is carried out similarly to that described, changing hands.

Clinical significance of enlarged inguinal and femoral lymph nodes. The inguinal joints are located lateral to the femoral joints, which are closer to the genitals. The differences are not only anatomical, but also clinical. An increase in the femoral lymph nodes is less alarming than an increase in the inguinal lymph nodes. Often the femoral lymph nodes increase due to mycoses of the feet. An increase in inguinal lymph nodes is much more informative and may indicate a malignant neoplasm. A biopsy of the inguinal lymph nodes can provide various diagnostic information; biopsy of the femoral lymph nodes usually reveals only a reactive process.

Clinical significance of enlarged popliteal lymph nodes. The clinical significance of enlarged popliteal lymph nodes is small. The popliteal lymph nodes are located so deep that palpation is inaccessible. Even if they can be palpated, the clinical significance remains unclear.

Sister Mary Joseph's Knot. This is a peri-umbilical nodule or a dense tumor-like formation detected upon examination or palpation of the navel. This extremely valuable symptom indicates metastasis of an intrapelvic or intra-abdominal tumor - most often stomach or ovarian cancer. This symptom was first described in 1928 by Dr. W. J. Mayo. His article is based on the observations of his first assistant surgical nurse, Mary Joseph of St. Mary's Hospital.