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INTRODUCTION
INTRODUCTION
LYMPH
Definition: Liquid of alkaline reaction found in
lymphatic vessels and derived from tissue fluid
Lymphatic system is absent in:
-C.N.S.
-Cornea
-Superficial layer of skin
-Bones
-Alveoli of lung
COMPONENTS OF LYMPH
Lymph
Water (96%)
Others (4%)
Solids
Cellular
Proteins
Lymphocyte
Lipids
Monocyte, macrophages
Carbohydrates
Plasma cell
Amino acids
Non nitrogenous s.
Electrolyte
LYMPHATIC VESSELS
LYMPHATIC VESSELS
Lymph
capillaries
LYMPHATIC VESSELS
Lymphatic
vessel
Lymph
Node
Lymphatic
trunk
Collecting
duct
Subclavian
vein
LYMPH FLOW
How???
120ml
THORACIC DUCT
+
RIGHT LYMPHATIC DUCT
Filtration >>
Reabsorption
>> Tissue
fluid
Increased
Hydrostatic
Pressure
>> movement
into
LYMPHATIC
CAPILLARIES
FUNCTIONS OF LYMPH
Nutritive
Drainage
Transmission of proteins
Absorption of fats
Defense
V
a
B.
D
I
O
HY
C.
D
I
O
CRIC
N UM
R
E
ST
III
VI
IV
V
b
LYMPHATIC DRAINAGE OF
VARIOUS STRUCTURES
Mandibular
incisors
Floor of the
mouthAnterior
Tongue
Lips
Lips
Cheeks
LYMPHATIC DRAINAGE OF
VARIOUS STRUCTURES
Teeth
Hard Palate
Oropharynx
Lateral wall
of nose
Hard
Soft Palate
Palate
LYMPHATIC DRAINAGE OF
VARIOUS STRUCTURES
Paranasal Sinuses
External ear
Scalp
EXTRA-NODAL LYMPHOID
TISSUE/ORGANS
MALT
PALATINE TONSIL
Almond shaped
TUBAL TONSIL
Around Eustachian tube openings in
the nasopharynx.
Extensions of pharyngeal tonsils
WALDEYERS RING
WALDEYERS RING
EXAMINATION OF LYMPH
NODES
Neck is slightly
flexed to achieve
relaxation of muscles
(iv) Consistency:
Metastatic nodes-hard;
lymphoma nodes-firm and rubbery;
hyperplastic nodes-soft.
Submental Nodes
Roll the fingers
below the chin with
patients head tilted
forwards
Submandibular
Nodes
Roll your fingers
against inner surface
of Mandible with
patient's head gently
tilted towards one
side
Parotid
(Preauricular)
Nodes
Roll your finger in
front of the ear,
against the maxilla
Occipital nodes
Post
auricular
(Mastoid Nodes)
Roll the fingers
behind the ear
Internal jugular
chain
Examine the
upper, middle and
lower groups.
lie deep to
sternomastoid
muscle which may
need to be
displaced
posteriorly
Transverse Cervical
Nodes
Supraclavicular
(Scalene Nodes)
Roll your fingers gently
behind the clavicles.
Instruct the patient to
cough or to bear down
like they are having a
bowel movement.
Occasionally an
enlarged lymph node
may pop up
Clinical relevance
31
ECHELON LYMPH
NODES
NODAL METASTAIS
CD44 is multistructural cell surface adhesion moleculeoverexpression of CD44 and its isoforms by tumor cells may
lead to increased lymphatic and hematogenous spread
HISTORY
PATTERNS OF NECK
METASTASIS
VIRCHOWS NODES
STAGING OF L.N.
LYMPHADENITIS AND
LYMPHADENOPATHY
CAUSES OF
LYMPHADENOPATHY
1.Infectious disease
A. Viral
-Infectious mononucleosis
-Infectious hepatitis
-Herpes simplex
-Rubella
-Measles
-HIV
B. Bacterial
-Cat scratch disease
-Brucellosis
-Tuberculosis
-Atypical mycobacterial infection
-Primary and secondary syphilis
-Diptheria
C. Fungal
-Histoplasmosis
-Coccidioidomycosis
D. Parasitic
-Toxoplasmosis
-Filariasis
E. Chlamydial
-Lymphogranuloma venerum
- Trachoma
INVESTIGATIONS
Histopathological
-Conventional FNAC- blind procedure
-Excisional biopsy of node
-Sentinal lymph node biopsy
Contrast lymphoangiography
Fine needle aspiration cytology- F.N.A.C
Ultrasound guidance
CT Guidance
- It is more accurate than blinded FNAC
-High sensitivity(89-98%), high specificity(9598%)
ROUNDED SHAPE:
benign node l:b=
2:1
Exceptionssubmental nodes
round rather than
ovoid in shape.
Lymphomatous
nodes are often
large and rounded
short/long ratio of
< 0.5 normal
value.
IRREGULAR MARGIN:
Nodes irregular
-larger than average.
Capsule of the node
-ill defined
-incomplete when
malignant cells extend
into perinodal soft tissue
or adjacent muscle.
-This is one of the most
significant ultrasonographic
features of malignancy
MULTIPLE NODES:
Nodes that are matted
together or multiple
in >1 zone -pathologic.
Inflammatory conditions
such as tuberculosis
or cat scratch disease
may demonstrate these
features.
Lymphomatous nodes
are often multiple in
number
ECHOGENICITY:
Homogeneous
echo architecture
in a large node
may reflect the
fish flesh gross
appearance seen
in lymphomatous
nodes
Areas of anechoic
echogenicity
within a node may
suggest necrosis
and metastatic
malignancy
PET SCAN
SENTINAL NODE
BIOPSY
Sentinel lymph node biopsy in squamous cell carcinoma of the head and
neck:10 years of experience.
ACTA otorhinolaryngologica Italica 2012;32:18-25
1.
2.
3.
SURGICAL TECHNIQUES OF
REMOVAL OF LYMPH NODES
CONCLUSION
Thank you