Investigations

•Investigations should be guided by the clinical presentation.

•Any lymph node enlargement in neck that persists for more than 2 weeks suggests need for investigation.

•Localised lymph node enlargement usually does not need any investigations.

Full blood count/blood film

i. Useful for detecting some lymphoproliferative disorders, chronic lymphocytic leukaemia and atypical mononuclear cells associated with viral syndromes.

ii. The presence of anaemia (or other cytopaenias) suggest significant underlying illness

Serological Examination

i.   Epstein-Barr virusii.  Toxoplasma (IgM, IgG)iii. Dengue (IgM, IgG)iv. Cytomegalovirus (IgM, IgG)v.  HIV

  Investigations for underlying

autoimmune conditions

i.  ANAii. Anti- dsDNAiii.Complement C3/C4iv. Rheumatoid factor

Biochemical tests

i.   LDHii.  Liver function testsiii. Calcium and phosphateiv.  Uric acid

Other tests

i.  ESR

ii. CRP

a. Chest x-ray

b.   CT scan

c.   Mammography

d.   PET scan

Imaging

Invasive methods

Fine needle aspiration

Lymph node excision biopsy

Lymph node aspiration-

1% lignocaine0.2 ml normal saline

• FNA + cytomorphological evaluation + flow cytometry

Lymph node excision biopsy showing follicular lymphoma