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What are the major causes of necrotic lymph nodes?
Necrotic lymph nodes, referring to lymph nodes that have undergone tissue death, can occur due to various underlying causes.
Some significant causes include:
- Infection: Infections are a common cause of necrotic lymph nodes. Bacterial infections such as tuberculosis (TB), staphylococcal infections, or abscesses can lead to necrosis within the lymph nodes. Viral infections such as HIV, herpes, or cytomegalovirus (CMV) can also cause necrotic lymph nodes.
- Lymphadenitis: Lymphadenitis is an inflammation of the lymph nodes, often caused by an underlying infection. If the infection becomes severe or is not adequately treated, it can lead to necrosis within the lymph nodes.
- Metastatic Cancer: Necrotic lymph nodes are most commonly caused by mycobacterial infection and metastatic illness, particularly from squamous cell carcinoma. When cancer spreads to lymph nodes or other distant areas from one area of the body, it is referred to as metastatic cancer. Necrosis within the lymph nodes may occasionally result from metastatic cancer cells as they spread and infect surrounding tissue.
- Lymphoma: Lymphomas are cancers that originate in the lymphatic system. Certain types of lymphomas, such as high-grade or aggressive lymphomas, can cause necrosis within the affected lymph nodes.
- Autoimmune Diseases: Some autoimmune diseases, such as systemic lupus erythematosus (SLE) or rheumatoid arthritis, can lead to inflammation and damage to the lymph nodes, potentially resulting in necrosis.
- Medications and Treatments: Certain medications, such as immunosuppressive drugs used in organ transplantation or chemotherapy agents, can affect the lymph nodes and increase the risk of necrosis.
- Bacterial infection, fungal infection, Whipple disease, and systemic lupus erythematosus are some less frequent causes.
- Vasculitis: Vasculitis refers to inflammation of blood vessels, which can affect the lymph nodes’ blood supply and result in necrosis.
- Granulomatous Diseases: Granulomas can develop inside the lymph nodes as a result of granulomatous disorders like sarcoidosis or specific fungal infections. Necrosis of these granulomas may occur occasionally.
The identification of necrotic lymph nodes often requires a thorough evaluation by a healthcare professional, which may include imaging studies (ultrasound, CT scan, MRI), biopsy, or fine-needle aspiration to determine the underlying cause. Treatment approaches vary significantly depending on the specific cause and may include antibiotics, antiviral medications, chemotherapy, radiation therapy, or surgical interventions, depending on the diagnosed condition.
Necrosis in lymph nodes shown on CT in many patients with nodal metastases may indicate that the primary tumor is aggressive and has a high degree of malignancy. However, the significance of nodal necrosis in patients with mediastinal Hodgkin disease remains uncertain.
When necrosis is identified in a lymph node biopsy, various entities should be considered in the differential diagnosis. Neoplastic conditions, especially lymphoma and metastatic carcinoma, must first be excluded.
Numerous benign conditions also cause necrosis in lymph nodes, and the presence or absence of granulomatous inflammation as well as other histologic features are useful in suggesting various possibilities.
Clinical information is very important in the differential diagnosis, and lymph node culture or other tests are often required to determine a specific diagnosis.
What research says about causes of necrotic lymph nodes?
A study on the thoracic CT scans of 76 patients who had newly diagnosed Hodgkin disease with mediastinal involvement with respect to the presence of necrosis (low attenuation, complex, fluidlike areas), the size and volume of the mass, the sites involved, extension (“E” disease), and the patients’ clinical response to treatment.
16 patients(21%) had necrotic nodes seen by CT scans. Regarding sex, age, stage, distribution of disease, presence of E disease, cell type, mass diameter, or presence of bulk disease (mass diameter/maximal thoracic diameter greater than or equal to 0.33), there was no statistically significant difference between these patients and those who did not have necrotic nodes.
The mass volume as measured by CT was not significantly (p = .08) larger (1274 cm3) than the group without necrotic nodes (876 cm3). An analysis of the various mediastinal sites involved showed no difference between patients with and without necrotic nodes.
Lastly, the presence of necrotic nodes had no significant impact on patients’ clinical response to treatment or survival.
The presence of mediastinal necrotic nodes appears to have little radiologic or prognostic significance in patients with newly diagnosed Hodgkin disease.
It is important to note that necrotic lymph nodes are often associated with an underlying condition or disease process. If you have concerns about necrotic lymph nodes or if you are experiencing symptoms such as enlarged or painful lymph nodes, fever, weight loss, or night sweats, it is recommended to consult a healthcare professional for a proper evaluation and diagnosis.
Necrotic lymph nodes, which refer to lymph nodes that have undergone tissue death or necrosis, can occur due to various causes.
Sources
Strickler JG, Warnke RA, Weiss LM. Necrosis in lymph nodes. Pathol Annu. 1987;22 Pt 2:253-82. PMID: 3317224. https://pubmed.ncbi.nlm.nih.gov/3317224/
