Etiological study of generalized lymphadenopathy in a tertiary care hospital

Subrata Halder, Bikram Kr. Saha, Debasis Sarkar, Srabani Ghosh


Background: This study was done to know about the clinical biochemical as well as radiological profile of patients presented as generalized lymphadenopathy in a tertiary care centre and to know the different causes of generalized lymphadenopathy.

Methods: 116 patients of generalized lymphadenopathy were included this study based on the inclusion and exclusion criteria. Detailed history, physical examination and relevant systemic examination including detailed examination of lympho-reticular system were done as per a structured proforma and necessary lab investigations were done for confirming diagnosis.

Results: Among 116 patients of generalized lymphadenopathy 59.5% were non-malignant causes where 40.5% diagnosed as malignant causes. Among them tuberculosis consist of 39 (33.6%), NHL 18 (15.5%), reactive lymphadenopathy 16 (13.8%), CLL and HD 8 (6.9%) each, ALL 7 (6%), SLE 5(4.3%), Kikuchi’s disease 4 (3.4%), AML and RA 3 (2.6%) each and castleman’s disease, phenytoin lymphadenopathy, metastatic lung and breast carcinoma 1 (0.9%) each. Cervical groups of lymph nodes were most commonly involved 86 patients (74.1%) followed by axillary groups 73 patients (62.9%). Lymph nodes size <1.5cm were mainly due to reactive causes where size >1.5cm were due to malignant and non-malignant granulomatous cases. FNAC give definite diagnosis 80.9% malignant cases where 76.8% in non-malignant cases. HPE shown definite diagnosis in 100% cases both malignant and non-malignant diseases.

Conclusions: Tuberculosis is most common cause of generalized lymphadenopathy followed by lymphoma. And reactive lymphadenitis is also an important consideration.



Generalized lymphadenopathy, Tuberculosis, Hodgkin and non-Hodgkin lymphoma, Reactive lymphadenitis, Chronic lymphoid leukemia, Kikuchi’s disease, Systemic lupus erythematosus, Acute myeloid leukemia, Rheumatoid arthritis, Castleman’s disease

Full Text:



Allhiser JN, McKnight TA, Shank JC. Lymphadenopathy in a family practice: J Fam Pract. 1981;12:27-32.

Robert F. Lymphadenopathy differential diagnosis and evaluation cover story. American Family physician. 1998;58(6):1-10.

Williamson HA Jr. Lymphadenopathy in a family practice: a descriptive study of 249 cases. J Fam Pract. 1985;20:449-58.

Patrick H, Dan L. Chapter 59. Enlargement of lymph nodes and Spleen: Kasper Dennis, Fauci Anthony, Hauser Stephen, Longo Dan, Jameson Larry. Harrison’s Principles of Internal Medicine. 18th ed. NewYork : McGraw Hill ; 2012:465-471.

Fijten GH, Blijham GH. Unexplained lymphadenopathy in family practice: An evaluation of the probability of malignant causes and the effectiveness of physicians' workup. J Fam Pract. 1988;27:373-6.

Zahir ST, Azimi A. Histopathologic findings of lymph node biopsy cases in comparison with clinical features. Pak J Med Sci. 2009;25(5):728-33.

Hirachand S, Lakhey M, Akhter J, Thapa B. Evaluation of needle aspiration cytology of lymph nodes in Kathmandu Medical College, Teaching hospital. Kathmandu University Medical Journal. 2009);7(2):139-142.

Mohan A, Reddy MK, Phaneendra BV, Chandra A. Aetiology of peripheral lymphadenopathy in adults: Analysis of 1724 cases seen at a tertiary care teaching hospital in southern India. The National Medical Journal of India. 2007;20(2):78-80.

Menon JM, Talpur AA, Roshan AS, Abdul RQ. An aduit of peripheral lymphadenopathy. PJS. 2007;33(3):183-6.

Ochicha ST, Edino ST, Mohammed AZ, Umar AB, Atanda AT. Pathology of Peripheral Lymph Node Biopsies in Kano, Northern Nigeria. Annals of African Medicine. 2007;6(3):104-8.

Selby CD, Marcus HS, Toghill PJ. Enlarged epitrochlear lymph nodes: an old physical sign revisited: J R Coll Physicians Lond. 1992; 26(2):159-61.

Bedi RS, Third GS, Arora VK. A clinic-pathological study of superficial lymphadenopathy in Northern India. Intl J Tub. 1987;34:189-91.

Richner S, Laifer G. Peripheral lymphadenopathy in immunocompetent adults. Swiss Med Weekly. 2010;140(7-8): 98-104.

Pangalis GA, Vassilakopoulos TP, Boussiotis VA, Fessas P. Clinical approach to lymphadenopathy. Semin Oncol. 1993;20:570-82.

Tatar D, Senol G, Alptekin S, Gunes E. Assessment of Lymph Node Tuberculosis in Two Provinces in Turkey. Jpn J Infect Dis. 2011;64:316-21.

Dandapat MC, Mishra BM, Dash SP, Kar PK. Peripheral lymph node tuberculosis: a review of 80 cases. Br J Surg. 1990;77(8):911-2.

Subrahmanyam M. Role of surgery and chemotherapy for peripheral lymph node tuberculosis: Br J Surg. 1993;80:154-8.

Kornberg A, Polliack A. Serum lactic dehydrogenase (LDH) levels in acute leukemia: marked elevations in lymphoblastic leukemia. Blood. 1980;56:351-.

Bierman HR, Hill BR, Reinhardt L, Emor A. Correlation of serum LDH activity with the clinical status of patients with cancer, Lymphoma and Leukemia: Cancer Res. 1957;12:660-7.

Berthier S, Bertrand MR, Ghirenghelli F, Bonnotte B, Besancenot JF, Lorcerie B. Elevation of serum lactate dehydrogenase-Diagnostic, prognostic and evolutive values. Presse Med. 2002;31(3):107-12.

Thomas JO, Adeyi D, Amanguno H. Fine-needle aspiration in the management of peripheral lymphadenopathy in a developing country. Diagn. Cytopathol. 1999;21:159-62.

Steel BL, Schwartz MR, Ramzy I. Fine needle aspiration biopsy in the diagnosis of lymphadenopathy in 1,103 patients- Role, limitations and analysis of diagnostic pitfalls. Acta Cytol. 1995;39(1):76-81.

Darnal HK, Karim N, Kamini K, Angela K. The Profile of Lymphadenopathy in Adults and Children. Med J Malaysia. 2005;60(5):590-9.

Adedeji MO. Malignant lymphoma in Benin City, Nigeria. East Afr Med J. 1989;66:134-40.

Obafunwa JO, Akinsete I. Malignant lymphoma in Jos, Nigeria: a ten-year study. Centr Afr J Med. 1992;38:17-25.