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Atallah A. Shaaban<br />
54<br />
Amyloidosis<br />
4. Infiltrative disease: sarcoidosis, amyloidosis.<br />
5. Drugs e.g. phenytoin.<br />
<strong>Basic</strong> <strong>Urology</strong><br />
Metastatic Lymph Node Enlargement:<br />
Cervical: from tumors of mouth, nasopharynx, thyroid and larynx.<br />
Supraclavicular nodes:<br />
- Lymphadenopathy suggests malignancy.<br />
- Cancer of the breast and bronchus may metastasize to the<br />
ipsilateral supraclavicular nodes.<br />
- The left supraclavicular nodes may be involved by metastases<br />
from abdominal organs e.g. gastric carcinoma or from the testis<br />
(Triosier's nodes or Virchow's node).<br />
Axillary nodes: from breast cancer.<br />
Mediastinal compression due to lymphoma or metastatic lymph<br />
nodes.<br />
Abdominal:<br />
- Retroperitoneal lymphadenopathy is especially seen in testicular<br />
tumors.<br />
- Physical examination should include palpation of the abdomen<br />
for evidence of bulky retroperitoneal nodal disease in the upper<br />
abdomen near the midline.<br />
Inguinal:<br />
- Palpate over the horizontal group below and parallel to the<br />
inguinal ligament and the vertical chain along the saphenous<br />
vein.<br />
- In malignant tumors of penis, scrotum and distal urethra in<br />
women, careful bilateral clinical evaluation of the inguinal<br />
lymph nodes is important.<br />
- Penile carcinoma is accompanied by considerable secondary<br />
infection.<br />
- The superficial lymphatics drain into the inguinal lymph nodes<br />
(horizontal and vertical groups). The deep lymphatics drain into<br />
the iliac lymph nodes.<br />
- 4-6 weeks course of broad spectrum antibiotics, re-evaluation.
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