LYMPH NODES [nodi lymphatici (PNA), lymphonodi (JNA)], lymphoglandnlae (BNA)] — the bodies of a lymphocytopoiesis and antibody formation located on the course of absorbent vessels and making together with them lymphatic system.
History of studying of these bodies, their development in phylogeny and ontogenesis, and also age changes — see. Lymphatic system .
Anatomy and histology
L. at. represent soft, pinkish-gray color of formation of a fabiform or tape-like form, located on the course absorbent vessels (see) near large blood vessels, and also in poles of flexion surfaces of extremities. They are located with groups, is more often on some nodes (sometimes to several tens). Number L. at. at different types of mammals: at a dog — apprx. 60, at a pig — 190, at a bull — 300, at the person — apprx. 460. Quantity of nodes in each group L. at. at the person varies over a wide range. Weight of all L. at. the adult — 500 — 1000 g that makes apprx. 1% of body weight. Size L. at. from 1 to 22 mm in length fluctuate; weight them reaches a maximum aged from 12 up to 25 years, then remains at one level up to 50 years then begins to decrease.
L. at., located in friable connecting fabric, have the fabiform form (e.g., in an axillary pole); between skin and muscles, near muscles and blood vessels they are as if thickened (e.g., occipital L. at.). The nodes which are on walls of perigastriums call parietal (somatic, T.), and nodes, through to-rye the lymph from internals — visceral proceeds; the nodes accepting a lymph as from bodies of a musculoskeletal system (muscles, joints), and from internals — mixed.
In a basis of the list of L. at. the anatomo-topographical principle is put: arrangement of L. at. in relation to bodies or areas of a body, large blood vessels. Topography of L. at., areas of a body from where the lymph brought in L.U gathers. on bringing limf, to vessels, and also the direction of outflow of a lymph from L. at. — see the table.
Bringing limf, the vessel (vas afferens) approaches L. at. from its convex party, at the same time walls limf, vessels merge with the capsule L. at., and the endothelium limf, vessels passes into an endothelium of a regional sine of a node (tsvetn. fig. 1). After passing through L. at. the lymph leaves it through taking out limf, a vessel (vas efferens) leaving through gate of a node. Bringing limf, vessels 2 — 4, and taking out — 1 — 2; diameter of the taking-out vessels is more, than bringing. On the way from the periphery to limf, to collectors the lymph passes not less than through one limf. node. So, from a stomach to chest channel (see) a lymph passes through 6 — 8 L. at., from a kidney — through 6 — 10 nodes. The gullet makes an exception since it limf, vessels directly fall into the chest canal therefore foreign debris (e.g., tumor cells) from walls of a gullet can directly get together with a lymph to a venous blood. L. at., the bodies lying in various areas, differ in a form, the sizes, and also interior that is connected with features of function of this or that part of a body; at the same time all L. at. have a similar structure (tsvetn. fig. 2).
Each L. at. it is covered with the connective tissue capsule (capsula nodi lymphatici), from a cut in a node its single thin branches — kapsulyarny trabeculas (trabeculae lymphonodi) depart. Where on a surface of L. at. there is impression — gate of a node (hilum nodi lymphatici), the capsule forms an okolokhilarny connective tissue thickening, from to-rogo in a parenchyma of a node quite thick portal (hilarny) trabeculas of a crossbeam, T depart.) L. at. (fig. 1). In some cases portal trabeculas connect with kapsulyarny that gives L. at. lobular structure. At somatic
L. at., as a rule, one gate, occurs at visceral three four gate (fig. 2). Through gate in L. at. arteries and nerves get, and there are veins and taking out limf, vessels. The capsule and trabeculas consist of collagenic, elastic and reticular fibers and single connective tissue cells; also smooth muscle cells and even their bunches capable to influence the size of a node and current of a lymph in it are observed. The thickest capsule at somatic nodes (to 355 microns at superficial inguinal nodes) and absolutely thin — at visceral nodes (7 — 44 microns at mesenteric nodes). In somatic L. at. trabeculas are better developed.
The stroma of L connected with the capsule and trabeculas. at. it is presented by reticular fibers and reticular macrophages, heterogeneous on the morfofunktsionalny features, to-rye in various departments of nodes have features in a structure. A gentle reticulum of reticular connecting fabric (see. Reticular fabric ) and the blood cells lying in its loops, hl. obr. lymphocytes at different stages of development and functioning, make a parenchyma of L. at., to-ruyu subdivide into cortical substance (cortex) and marrow (medulla).
Cortical substance of a parenchyma is closer to the capsule, on color it more dark because of a dense arrangement in it cellular elements. Marrow lighter, it occupies the central part L. at. also prilezhit to portas. In cortical substance are located rounded shape of education to dia. apprx. 0,5 — 1 mm — limf, small knots, or follicles (noduli s. folliculi lymphatici), the V-lymphocytes containing preferential (see. Immunocompetent cells ). The quantity and the sizes limf, follicles are various. Emergence limf, follicles also in marrow at nek-ry animals after a strong antigen challenge is described.
Distinguish limf, follicles without the light centers (primary) and limf, follicles with the light centers (secondary); the last were called by the germinal centers, and also the reactive centers because of existence in them of a large number mitotic of the sharing cells. On the periphery limf, a follicle and around the light center (centrum lucidum) there is tighter cellular coat consisting preferential of average and small lymphocytes (see). In surrounding limf, follicles of a diffusion adenoid tissue allocate the interfollicular zone (the cortical plateau) located closer to the capsule of a node and a zone, boundary with marrow — paracortical (paracortex), or timuszavisimy, a zone where peculiar post-capillary venules from a cubic form are revealed by an endothelium, through to-ry migration of lymphocytes is carried out. In an internal (paracortical) zone of cortical substance of a cell are located less densely, than in an outside zone. Blum and Fositt (W. Bloom, D. Fawcett, 1975) established that the majority of lymphocytes in a paracortical zone L. at. are recirculating T lymphocytes.
The parenchyma of marrow is presented by the pulpy tyazha (chorda medullaris) stretching from internal departments of cortical substance to gate of a node, and delimited from each other and from trabeculas by wide intermediate brain sine (sinus intermedius medullaris). Pulpy tyazh, as well as limf, follicles, are a zone of accumulation of the V-lymphocytes connected with development of humoral immunity. In pulpy tyazha there are plasmocytes, macrophages and other cellular elements adenoid tissue (see). A ratio of the space occupied on cuts of L. at. cortical and marrow, changeably. In M. R. Sapin, I. A. Yurin and L. E works. An ethynegene (1978) it is established that a structure cortical and marrow, and also their cellular structure depend on localization of L. at., age, sex, specific features of an organism.
Between a parenchyma, the capsule and trabeculas there are narrow spaces — the cracks called limf, L.U's sine. (sinus lymphonodi). Directly under the capsule, between the capsule and cortical substance is subcapsular, or regional, a sine (sinus subcapsularis), in to-ry vessels open bringing limf. From a regional sine between trabeculas and cortical substance cortical intermediate sine (sinus intermedius corticales) proceeding in the brain sine located between pulpy tyazha and portal trabeculas lie. Brain sine pass into a portal sine (sinus hilaris), from to-rogo there are taking out limf, vessels.
On sine flows lymph (see), come to L. at.; from a regional sine where it gets from bringing limf, vessels, the lymph comes to sine cortical and marrow, then to a portal sine and from it in taking out limf, vessels. On the way the lymph as if filters also through a parenchyma of a node and flows on a regional sine that makes shorter and direct way from bringing limf, vessels to taking out. Brain sine are wider, than cortical and regional. The sizes and permeability of walls of sine change depending on funkts, conditions of L. at., regional, age and sexual features of an organism. Walls of sine are formed by the flattened endoteliopodobny cells — so-called coastal, littoral, retotelialny cells. Cells of walls of sine, adjacent to the capsule of a node, have simpler structure, than the cells forming walls of intermediate sine. In gleams of sine there is a network of reticular fibers and cells, edges can serve as a barrier to the coarse particles, including microbic bodies and tumor cells brought by a lymph. In sine of a node the blood cells which arrived with a lymph and migrating from a parenchyma of a node are found. Through walls of sine in a parenchyma of L. at. get and there foreign debris collect (e.g., coal dust in regional L. at. respiratory organs).
Each L. at. it krovosnabzhatsya plentifully. Arteries get into a node not only through portas, but also via the capsule. On trabeculas of an artery go to a parenchyma of L. at., where branch to capillaries, to-rye in cortical and marrow create melkopetlisty networks. The capillary network of each follicle is formed during the branching of the arterioles getting into it (1 — 3). The veins forming on the periphery of follicles merge with venules of adjacent departments of the cortical plateau and pulpy tyazhy and on trabeculas go to gate of a node. The close arrangement of post-capillary venules to walls of sine of L is noted. at. The post-capillary venules which are especially located in a paracortical zone have the endothelial cells of a cubic form and quite wide interendothelial cracks capable to pass lymphocytes upon their transition from blood to a lymph and back. Feature of capillaries of L. at. reticulation of their basal membrane connected with shoots of reticular macrophages of a stroma of L is. at.
Within the first year of life in L. at. in response to an antigen challenge the germinal centers of lymphoid follicles begin to be enlarged considerably, in a post-puberty nomas the period relative reduction of a bast layer limf, nodes, growth of connecting fabric, its hyalinosis is usually noted. Quantity of a parenchyma in L. at. in connection with growth of connective tissue trabeculas and accumulation of fatty segments decreases a little with age. The reduction of the germinal centers of follicles limf, nodes begins between 30 and 40 years and then slowly progresses; at old men they tend to disappearance. The reduction of the germinal centers is observed also at a row hron, diseases. At advanced age the number of the functioning L. at. decreases due to substitution by their connecting fabric, atrophies of small nodes and accretion with each other nearby of lying. As a result at persons of more advanced ages prevail large limf. nodes.
L. at. represent bodies of a lymphocytopoiesis, i.e. in their cortical and marrow lymphocytes are formed: V-lymphocytes — in the light centers of follicles, T lymphocytes — in a paracortical zone; in L. at. the leukocytic factor stimulating reproduction of cells is developed. End-stage lymphocytes get to sine of L. at., and from them with a lymph — in taking out limf, vessels. Since on the way to a chest channel the lymph passes several L. at., it is strongly enriched lymphocytes (see).
L. at. perform also baryernofiltratsionny function, representing as if the drainage system which is biol, a barrier of an organism. In gleams of sine of L. at., the reticular macrophages and fibers penetrated by network, the foreign debris arriving with current of a lymph, microbic bodies, tumor cells are late. They not only are late in sine, but also are actively captured macrophages (see. Phagocytosis ). Protective function is connected also with participation of L. at. in development immunity (see).
Immunol, function L. at. it is expressed in participation of lymphocytes in immune processes of an organism, and also in formation of plasmocytes and production of immunoglobulins.
Participation of L is proved. at. in processes of digestion and a metabolism — proteins, fats, vitamins (And, In, With, D). Together with limf, vessels of L. at. perform function of depot of a lymph, participate in redistribution of liquid and uniform elements between blood and a lymph, a part of the arrived liquid can be deposited with L. at.; they participate also in a lymph drainage.
Activity of L. at. is under control of a nervous system and humoral factors. Nerve fibrils L. at. treat sympathetic and sensitive spinal. From the humoral factors influencing on fiziol, functions L. at., it should be noted a role of hormones of cortical substance of the adrenal glands influencing generally intensity of a lymphocytopoiesis.
Methods of a research
Research of peripheral L. at. begins with a palpation and outer inspection of area of their arrangement. Determine the sizes, number of the increased nodes, their density and morbidity, existence of hypostasis of hypodermic cellulose and reddening of the respective site of skin that is most often observed at acute inflammatory processes; one L can be increased. at. or several nodes of one group that usually takes place at reactive changes of L. at. From deep L. at. define by a palpation only much the increased mesenteric nodes (e.g., at a lymphoid leukosis, a lymphogranulomatosis).
Research of visceral groups L. at., and also other areas not available to a palpation and puncture, it can be carried out rentgenol. by methods; structural changes of group retroperitoneal and mediastinal L. at. are defined at a survey and layer-by-layer X-ray analysis. A valuable diagnostic method is limfografiya (see).
Morfol, analysis of L. at. it is carried out tsitol, and gistol, by methods (see. Histologic methods of a research , Cytologic research ). Set of these methods provides the most high diagnostic level of a research. Tsitol. subject to a research punctate L. at. Smears and prints from the received punctate, just as from fabric of biopsirovanny or quickly remote L. at., paint by Romanovsky's method — Gimza, Pappengeym and Leyshman with dokrasky azureozinovy mix. For the purpose of thinner differentiation of cells apply cytochemical, the techniques revealing the maintenance of lipids, mucopolysaccharides, oxidation-reduction, hydrolytic and other enzymes, availability of slime etc. Punctate L. at. it can be subjected to electronic microscopic examination, a cut allows to characterize a condition of intracellular structures and level of exchange processes. Tsitol, a method allows to conduct an urgent research L. at. also provides the characteristic of their cellular structure and by that promotes diagnosis of a large number of diseases. The advantage of a method is also the possibility of repeated capture of punctate during the different periods of a disease and at different stages of treatment.
Gistol, the analysis allows to judge degree of safety of structure, ratios of cortical substance, an okolokorkovy zone and marrow L. at., and also their cellular structure. It gives an idea of a condition of the follicular device, a stroma, vessels, surrounding fabrics that it is necessary for the solution of a question of degree of prevalence patol, process, about character and level of an immune response.
Received by a biopsy or operational removal of L. at. are exposed to macroscopic survey, since a condition of the capsule, and then fabric of a node on its section. It is desirable to carry out a section parallel to small axis L. at. It is not recommended to take for the general diagnostic testing of L.U. submaxillary and inguinal areas since the nasopharynx and the lower extremities are most often infected. Pieces of L. at. fix in neutral formalin, liquid Carnoy or in any other solution allowing to carry out differentiation of cellular forms in cuts. For receiving gistol, cuts paraffin embedding is desirable. For the purpose of detection of the contents of lipids in cells, and also gistoenzimokhimichesky researches use the cryostately cuts or cuts received by means of the freezing microtome.
The fullest idea of structure of L. at. it is possible to receive at use of a complex of the all-survey and special techniques including colourings hematoxylin-eosine, pikrofuksiny, impregnation by silver by Gomori's method, Foote, CHIC reaction, reaction to nonspecific esterase, etc.
Results tsitol, and gistol, researches compare with the data of a case history, methods of treatment which are carried out by diagnostic manipulations including with data of a limfografiya.
Apply also immunomorfol. methods of a research (see. Immunomorphology ).
Specific weight of each of the above-stated methods of a research in many respects is defined by character patol, process and a phase of a disease. In the absence of enough convincing proofs of specificity of the revealed signs of defeat of L. at. bacterial, researches of fabric L can be decisive. at., and also results serol, researches.
In addition to the qualitative characteristic of cellular structure of L. at., calculation of a ratio of cellular forms L is reasonable. at. — so-called limfogramma. It is especially important for differential diagnosis of reactive polyadenites and initial forms of hemoblastoses with defeat of L. at. Reactive lymphadenites, though are followed by increase in number of young and even blast lymphoid cells, reticular cellular elements, however their quantity, and also the number of large hyper basphilic cells and plasmablasts does not exceed 15 — 18% while at lymphoma (gematosarkoma) quantity of blast unripe lymphoid elements in L. at. increases to 60 — 80%, according to E. N. Bychkova (1977) and L. G. Kovalyova et al. (1978). At lymphadenites there are no signs of anaplaziya of cellular elements, the reticular or blast hyperplasia has focal character. During the carrying out the differential diagnosis it is necessary to consider the nature of changes gemogramma (see) and miyelogramma (see). If at reactive polyadenites indicators of hemoglobin, erythrocytes and thrombocytes remain normal and only occasionally are found a passing neutropenia with a relative lymphocytosis and emergence of plasmocytes, and the miyelogramma at the same time has no aberrations, then at hemoblastoses of times the arisen disturbances persistently progress: a gemogramm and a miyelogramm the accruing lymphocytosis, emergence of blast cells and increase of their quantity can reveal.
it is the Most frequent in L. at. the picture of the reactive changes arising in response to various patol, processes developing in an organism is observed (inflammatory changes in the nearby or remote bodies, blastomatous! growth, a state after vaccination, etc.). Increase in L. at. it can be expressed in different degree, the capsule of a node is strained, vessels are injected. On a section fabric L. at. looks bulked up, a juicy look, gray-pink color.
Microscopically the complex morfol, the signs testimonial of an immune response comes to light. The last proceeds on ooze of preferential humoral or cellular reaction with a hyperplasia of an adenoid tissue, characteristic of this or that type. At humoral type of an immune response expansion of cortical and okolokorkovy zones L. at. it is caused by increase in number of follicles with the wide reactive centers (fig. 3) rich with cells. Among these cells large cells from the nukleola known under the names «plasmablasts», «immunoblasts», «germinoblasta» etc. attract attention; are well visible macrophages (see), the nuclear inclusions containing in cytoplasm, lymphocytes (see) and lymphoblasts, cells in a condition of a mitosis. In expanded brain tyazha the number is increased plasmocytes (see).
Reaction of an immune response on cellular type is characterized by preferential expansion of an okolokorkovy zone. The reactive centers in follicles can be reduced in sizes or be absent completely in this connection an impression of continuous mass of lymphocytes is made. Expansion of sine with accumulation in their gleams and in intersinus spaces is characteristic of this state histiocytes (see), lymphocytes, macrophages, can come to light also neutrophylic and eosinophilic leukocytes (see). Gleams of post-capillary venules of an okolokorkovy zone are filled with lymphocytes. The immune response can proceed on the mixed type with morfol, signs of the cellular and humoral answer. Dynamics of changes of L. at. at an antigen challenge on terms it is studied in an experiment on animals in detail.
Against the background of the above described immune response the changes characteristic of this or that disease or influence can come to light morfol. So, e.g., at metastasises of cancer the immune response proceeds more often as cellular immunity. Cells of malignant growth appear first of all in a subkapsulyarny layer, and then in deep sine. The replacement of tissue of a node tumor cells quite often is followed by development of a necrosis and fibrosis.
In response to introduction of lipids, in particular at a limfografiya, in L. at. there can be changes which are characterized at first by accumulation in sine of lipids and proliferation of macrophages, then in fabric of a node granulomas with the huge multinucleate cells containing lipids form; in these cases eventually the structure of a node is recovered.
Lymphadenitis (see) — inflammatory change of L. at., usually begins with increase in one or several L. at. Revealed in early phases of lymphadenitis morfol, changes are often poor that causes difficulties at differential diagnosis, especially with early stages of hemoblastoses. At acute lymphadenitis hypostasis and razvolokneny capsules is sharply expressed. There can be certain sites of abscessing or multiple microabscesses (e.g., at a disease of cat's scratches). Purulent lymphadenitis is characterized by development of the centers of an inflammation with massive leukocytic infiltration, sites of a necrosis reach the considerable sizes.
Hron, lymphadenites are morphologically very various that is connected with various etiology and different phases of a disease. The capsule of a node can be thickened, soldered to surrounding fabrics. At microscopic examination diagnosis of a disease is defined by character of an immune response, localization and dynamics of development of granulematozny educations, features of structure of colossal cells, among to-rykh there can be Langkhans's cells (at tuberculosis), cells of a sarcoidosis, etc. In differentiation hron, lymphadenites distribution of epithelioid histiocytes and macrophages (matter at an infectious mononucleosis, a leprosy, a toxoplasmosis), the nature of necrotic changes and their localization, and also a tendency to development of fibrosis and a sclerosis (at a brucellosis, a tularemia).
Unlike reactive and primary and inflammatory diseases, malignant proliferative defeats of L. at. are characterized by sharp disturbance of structure already in early stages of a disease, and with its development — full deleting of the figure L. at. There are indiscernible follicles, sine, brain tyazh, the adenoid tissue is replaced with the proliferating cells defining type of a tumor (fig. 4). Infiltration by tumor cells of the capsule L. at. and a surrounding fatty tissue is a sign to aggression of tumoral growth, conglomerates of the increased nodes are quite often formed. At a macrofollicular lymphoblastoma disturbance of structure of L. at. it is connected with massive proliferation of the follicles consisting generally of sharply expanded reactive centers and a narrow zone of lymphocytes rich with cells. The late stage is characterized by deleting of the drawing due to proliferation of cells of one clone (see).
In group of histiocytoses the X widespread changes of L. at. with their increase and proliferation of the cells accumulating products of a lipometabolism are observed at Letterer's disease — Siwa. In regional L. at. a liver and a spleen at a disease Gosha can see proliferation of the cells containing tsitozida and tseremida. Peculiar picture of plentiful accumulation in cells of mezenterialny L. at. mucopolysaccharides it is found at Whipple's disease (see. Intestinal lipodystrophy ).
Increase in separate groups L. at. can take place at extra marrowy hemopoiesis (see), characterized by emergence in fabric L. at. the hemopoietic cells — nuclear forms of a red row, a different maturity of leukocytes, megacaryocytes and a reticulin stroma.
Atrophic changes in L. at., developing at immunodeficiency, a thicket are characterized by disturbances of immunity of the humoral or mixed type; research L. at. finds narrowing of a zone of cortical substance with reduction of number of follicles or their total absence. At heavy disturbances of immunity along with disappearance of cortical substance the thickening of the capsule, development of fibrosis with an obliteration of a peripheral sine, lack of plasmocytes, falloff of number of stromal cells is noted. The atrophic changes proceeding with substitution of an adenoid tissue a fatty tissue usually begin at gate of a node and extend towards the center with retention of structure of L.U. only on the periphery in the form of a narrow ring. They can be observed at cachexias of various nature, hypoplastic states (at assessment of degree of an atrophy it is necessary to consider age involution). Atrophy of L. at. it can be observed at massive development of fibrous fabric or a sclerosis in the outcome it is long the current inflammatory processes.
Decolourization of L. at. with acquisition of a rusty shade quite often accompanies the hemosiderosis developing at hemochromatosis, the strengthened hemolysis, in particular at hypoplastic anemias, etc. Dark and black coloring comes to light in regional L. at. respiratory tracts at various forms of a pneumoconiosis can be also followed by disturbance of structure of L. at. with development of granulomas, fibrosis and a sclerosis.
L. at. can be involved in various patol, processes, and a wedge, the picture is often not specific. Irrespective of an etiology patol, process in L. at. is defined by their increase, sometimes formation of conglomerates of nodes; more often regional L increase. at., but defeat can be and generalized. Depending on character and degree of manifestation patol. process increase in L. at. can be small or considerable. L. at. can be painful or painless; the consistence of nodes can be various — myagkoelastichesky, pasty, dense.
At acute purulent inflammatory processes (phlegmon, abscess, an anthrax, a furuncle, etc.) first of all regional L are involved. at.; they increase, become friable, edematous and painful (see. Lymphadenitis ); quite often skin over them reddens, and sometimes and ulcerates. Such nature of changes is connected with sedimentation of the microbic agent in fabric L. at., where it is englobed, and cells of L. at. giperplazirutsya. Hypostasis develops, increase to-rogo causes morbidity because of small distensibility of the capsule L. at. However cells of an adenoid tissue usually quickly neutralize and destroy microbes therefore suppuration of L. at. it is observed seldom.
At hron, inflammatory processes the L swelled. at. the L is expressed more weakly. at. increase to a lesser extent, their morbidity either is insignificant, or is absent absolutely. As at hron, inflammatory processes proliferation of elements of an adenoid tissue prevails and processes of an immunogenesis, involvement in the general patol, process of L are expressed. at. it is regarded as all-reactive process (a nonspecific polyadenitis), to-rogo the phenomenon of transformation of lymphocytes under the influence of antigen in a cell, actively proliferating and capable to products of antibodies — an immunoblast (fig. 5) is the cornerstone. At the same time quite often comes to light that reaction of L. at. surpasses a wedge, manifestations of a basic disease, especially in cases inertly current hron, the inflammatory centers (e.g., at pharyngitis, periodontitis, cholecystitis, etc.). Similar mechanism of increase in L. at. it is observed also at autoimmune diseases (autoimmune hemolitic anemia, a lupus erythematosus, rheumatism, rhematoid polyarthritis).
Primary specific defeat of L. at. develops in connection with a tropnost of the activator patol, process to an adenoid tissue. Treat such processes tuberculosis of L. at., tularemia, plague, leprosy, actinomycosis, pakhovy lymphogranulomatosis. However at specified inf. processes, and also at a brucellosis, toxoplasmosis and nek-ry other diseases reaction of L is possible. at. and as a nonspecific polyadenitis.
The combined reactive and specific (virus) defeat of an adenoid tissue happens at an infectious mononucleosis, an infectious lymphocytosis and a disease of cat's scratches.
Malignant defeat of L. at. can be two types: development of primary center of defeat in one of L. at. with the subsequent involvement of other nodes and secondary, metastatic, a drift of tumor cells. Primary center of tumoral process in L. at. it is observed only at to a lymphoma (see), including at lymphogranulomatosis (see); at the same time there is innidiation at first in regional, and then and in the remote L. at. Increase in L. at. results from reproduction of cells of a tumor, to-rye as if replace fabric L. at. At a palpation the single increased L are defined. at. or conglomerates of a plotnoelastichesky consistence, mobile, not soldered to surrounding fabric. Even significant increase in L. at. seldom is followed by pain; pains usually arise at a prelum of vessels, nerves quickly increasing conglomerate L. at.
Metastasises in L. at. — the most frequent type of their malignant defeat. Metastasises of cancer are noted more often in L. at., being on an outflow tract of a lymph from the struck body. At metastasises of cancer and melanoma of L. at. usually plotnovata, can be painful at the expense of reactive hypostasis of a stroma. Wedge, a picture is defined by the nature of an initial tumor.
Increase in L. at. — a characteristic wedge, a syndrome at hemoblastoses (see). Especially often L. at. increase at limfoproliferativny processes. L. at. at the same time quite often remain painless, not soldered to skin, mobile, a pasty consistence. At the same time L. at. one group the slow-moving conglomerate, a consistence to-rogo more densely, than separate L can form. at. Increase in L. at. an abdominal cavity, and especially mediastinums, usually is the bad predictive sign indicating a severe disease.
At myeloproliferative diseases, in particular at hron, a myeloleukemia (see. Leukoses ), occasionally at a myelofibrosis, increase in the separate groups L struck metastatichesk can come to light. at. Increase in L. at. at myeloproliferative processes it is possible to consider as an adverse predictive sign.
Diagnosis of defeats of L. at. usually is defined by symptomatology of a basic disease. Wedge, data: minor change of a state, subfebrile temperature, non-constant (main, small) increase in L. at., the general bent to allergic reactions like small tortoiseshell speak about the reactive nature of defeat of L. at. Quite often there is a need to apply special methods of a research. Dynamic observation is important: positive dynamics a wedge, and gematol, symptoms against the background of the desensibilizing and antiinflammatory therapy testifies to the reactive nature of changes in L. at.; lack of positive dynamics, involvement in process of new L. at., their further increase force to suspect a malignant disease from group of hemoblastoses and to deepen diagnostic searches.
Table. List of lymph nodes of the person and some anatomo-topographical information about them
Anatomy, physiology — See bibliogr. to St. Lymphatic system .
Pathology — Zedgenidze G. A. and Cibas A. T. Clinical limfografiya, M., 1977, bibliogr.; Zubovsky G. A. ipavlovv.g. Skennirovaniye of internals, page 121, M., 1973; Kaganov A. L. About normal limfoadeno-gram, the Doctor, business, No. 10, page 885, 1954; Kassirsky I. A. and Alekseev G. A. Clinical hematology, M., 1970; Kovalyova L. G. and Bychkov E. N. O to diagnosis of reactive nonspecific polyadenites, Probl, gematol. and modulation, blood, t. 20, No. 10, page 9, 1975; Nikitina N. I. Value of a cytologic research of punctates of the increased lymph nodes, Vopr, onkol., t. 5, No. 7, page 55, 1959, bibliogr.; A. Fiziologiya's palikar and pathology of lymphoid system, the lane with fr., M., 1965, bibliogr.; The guide to pathoanatomical diagnosis of tumors of the person, under the editorship of N. A. Krayevsky and A. V. Smolyannikov, page 356, M., 1976; The guide to cytologic diagnosis of tumors of the person, under the editorship of A.S. Petrova and M. P. Ptokhova, page 266, M., 1976; Fontalin L. N. Immune responsiveness of lymphoid bodies and cells, L., 1967, bibliogr.; With and of of I. and. lake of Lymphoreticular disease, Oxford and. lake, 1977, bibliogr.; Duha-m e 1 G. Histopathologie du ganglion lymphatique, P., 1969; Kellner B., Lapis K. u. Eckhardt S. Lymphk-noten Geschwiilste, Budapest, 1966; Lym-phographie bei malignen Tumoren, hrsg. v. M. Lunning u. a., Lpz., 1976, Bibliogr.; Pavlovsky A. Contribution of cytology to the study of lymphopathies, Acta haemat. (Basel), v. 36, p. 296, 1966.
L. G. Kovalyova (gems.), H. M. Nemenova, T. G. Protasov (mt. issl., stalemate. An.), M. R. Sapin (An.).