Differental diagnosis of painless lymphadenopathy: challenges in everyday clinical practice with case report and literature overview

Abstract

 Introduction. Lymphadenopathy is defined as an abnormal
finding during a physical examination, indicating
that the lymph nodes are abnormal in size, consistency, and
number. A thorough personal history and detailed physical
examination allow the physician to formulate an appropriate
diagnostic strategy. It is important to approach differential
diagnoses with caution, as there is a wide range of potential
causes and often nonspecific clinical presentations. Painless
lymphadenopathy, in particular, presents a significant clinical
challenge, especially in primary healthcare settings.
Case report 1. A 54-year-old female patient presented
with a lump that she had noticed in her left groin. A detailed
physical examination revealed a painless lump measuring
25 mm in diameter. An ultrasound of the groin showed an
enlarged lymph node with peripheral vascularization. A biopsy
of the lymph node confirmed the presence of metastatic
cervical carcinoma. A PET-CT scan indicated a solitary lump
along the upper uterine margin, along with liver metastases.
The oncology team recommended three weeks of chemotherapy.
The patient has since undergone six cycles of chemotherapy.
Case report 2. A 76-year-old male patient presented
with a lump in his right armpit that had been present for several
months, but he reported no other symptoms. A physical
examination revealed a lump the size of an apple located under
the right armpit, which was painless to the touch. A biopsy
confirmed that it was a metastatic melanoma. An abdominal
ultrasound showed the presence of liver metastases. A dermatological
examination revealed a suspicious skin tumor in the
lumbar area, measuring 1 cm in diameter, also highly suggestive
of melanoma. After excising the lesion, the pathological
findings confirmed the diagnosis.
Conclusion. Painless lymphadenopathy is a common
finding that presents diagnostic challenges, with a broad
range of causes that can vary from benign to malignant.
Timely recognition and appropriate interventions are crucial
for treatment outcomes.