성인 경부 림프절병증의 감별진단과 단계적 진단 접근

초록

Purpose: Cervical lymphadenopathy is frequently encountered in both primary and specialty care. Most cases are benign and self-limiting; however, persistent lymphadenopathy or lymphadenopathy with high-risk features may be the initial manifestation of metastatic malignancy, lymphoma, tuberculosis, or systemic inflammatory disease. This article reviews the differential diagnosis and stepwise evaluation of cervical lymphadenopathy in adults.Current concepts: Lymphadenopathy denotes abnormalities in lymph node size, number, consistency, or architecture and most commonly reflects reactive hyperplasia or infiltration by malignant or other abnormal cells. Causes may be categorized as malignancies, infections, autoimmune or systemic inflammatory disorders, miscellaneous or uncommon conditions, and iatrogenic causes. The initial evaluation should assess age; duration and location; nodal tenderness, consistency, and mobility; systemic symptoms; exposure and medication histories; and the presence of warning signs. Important red flags include age older than 40 years, supraclavicular location, a node size of 2 cm or larger, progressive enlargement, firm or fixed nodes, generalized lymphadenopathy, cytopenia, hepatosplenomegaly, and constitutional symptoms such as fever, night sweats, or weight loss. Laboratory tests, ultrasonography, computed tomography, and tissue biopsy should be selected according to the suspected etiology and the clinical probability of serious underlying disease.Discussion and conclusion: Low-risk, localized lymphadenopathy can often be managed with short-term observation. By contrast, persistent, unexplained, progressive, or high-risk lymphadenopathy warrants targeted laboratory testing, imaging, and histopathological evaluation. Empirical antibiotics should be reserved for suspected acute bacterial lymphadenitis. Corticosteroids should be avoided before a diagnosis is established because they may obscure the histopathological features of lymphoma or another serious disease.

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