Peripheral lymphadenopathy in Nigeria

An analysis of 294 enlarged peripheral lymph node biopsies in Ife, Nigeria, revealed that the underlying disease in 51.7% was chronic inflammation while malignant diseases accounted for 48.3%. The order of frequency of the lesions was reactive hyperplasia (29.3%), metastatic cancer (24.5%), malignant lymphoma (23.8%), tuberculosis (15.6%) and toxoplasmosis (3.7%). One-third of the metastases were of undetermined origin. The neck which accounted for 53% of the biopsies, was the most frequent site for tuberculous adenitis, toxoplasmic lymphadenitis, and malignancies. The axilla was involved in 15% of the cases and was the most common site for metastatic breast carcinoma. The inguinal lymph nodes were also involved in 24% of the cases and had the highest occurrence of melanoma, reactive hyperplasia and parasitic granuloma. The habit of bare-foot walking leading to repeated trauma and infection is implicated in the high incidence of inguinal node reactive hyperplasia. This study demonstrates that lymph node malignancies and chronic granulomatous infections present a problem of increasing diagnostic and therapeutic importance and furthermore, it emphasizes that physicians in Nigeria should consider toxoplasmosis in the differential diagnosis of peripheral lymphadenopathy.