29 Generalized pruritus is a concerning symptom because it manifests in 30% of patients with Hodgkin’s disease31 and 10% of patients with non-Hodgkin’s lymphoma.32 Physical Examination All patients with LAP should learn more undergo a complete and systematic

physical examination. Any palpable lymph node should be evaluated for its location, size, consistency, fixation, and tenderness. Location Determining whether LAP is localized or generalized makes the differential range narrower. An enlarged node in a lymphatic-rich region mostly presents a local disease. The presence of a red lymphangitic streaking (lymphangitis) may be detected in Inhibitors,research,lifescience,medical a localized infection.33 Nodes that are associated with malignancy tend to involve several groups of nodes. 34 LAP in the supraclavicular area has the highest risk of malignancy; this risk is 90% in patients more than 40 years old and 25% in those under 40 years old.12 The Virchow node, in the left supraclavicular Inhibitors,research,lifescience,medical area, suggests intra-abdominal malignancies

(e.g., gastric carcinoma), while in the right side suggests intra-thoracic malignancies. Size It is suggested that palpable supraclavicular, iliac and popliteal nodes, epitrochlear greater than 0.5cm, and inguinal nodes larger than 1.5 cm are abnormal.16 The nodes in other areas are considered Inhibitors,research,lifescience,medical as abnormal if their diameter exceeds one cm.2 However, there is no uniform nodal size at which the greater diameter can raise suspicion of a neoplastic etiology. Pain and Tenderness Pain

and tenderness on a lymph node is a non-specific finding. It is typically due to infection. In some cases, pain is induced by hemorrhage into the necrotic center of a neoplastic node, immunologic stimulation of pain receptors, or rapid tumor expansion.12 Consistency Acute inflammation by infiltrating the Inhibitors,research,lifescience,medical node may make it more consistent, with concomitant tenderness due to the tension on the capsule. Chronic inflammation Inhibitors,research,lifescience,medical also leads to fibrotic changes, making the node hard in palpation. Stony-hard and painless nodes are usually signs of metastatic cancer or granulomatous disease. Firm and rubbery nodes can imply lymphoma. Matted lymph nodes are described when a group of nodes are conglomerated. They can be either due to benign (mycobacterial infection and sarcoidosis) or malignant (lymphoma and metastatic carcinoma) disorders.1,16,35 Mobility LAPs resulting from infections and collagen vascular diseases are usually freely movable in the subcutaneous region. Rubbery mobile nodes are associated PD184352 (CI-1040) with lymphoma. Nodes that are associated with malignancy are often fixed to the skin or surrounding tissues.36,37 Organomegaly (especially splenomegaly) is sometimes associated with LAP, as in infectious mononucleosis, acute lymphoma, Hodgkin’s disease, non-Hodgkin’s lymphoma, and sarcoidosis.29 Skin should also be examined for unusual lesions suggesting malignancy such as melanoma, and for traumatic lesions that potentially can be an inoculation site for microbial germs.