Differential Diagnosis for Focal Cortical Thickening of a Lymph Node
Single Most Likely Diagnosis
- Reactive Lymphoid Hyperplasia: This condition is a common response to infection, inflammation, or other stimuli, leading to lymph node enlargement and cortical thickening. The thickness of over 0.3cm can be seen in reactive nodes, especially if the process is pronounced.
Other Likely Diagnoses
- Lymphoma: Both Hodgkin and non-Hodgkin lymphomas can cause focal cortical thickening due to the proliferation of malignant lymphocytes. The thickness can vary but often exceeds 0.3cm as the disease progresses.
- Metastatic Disease: Cancer from other parts of the body can metastasize to lymph nodes, causing focal or diffuse enlargement, including cortical thickening. The pattern and extent can vary depending on the primary tumor.
- Infectious Diseases: Certain infections like tuberculosis, cat-scratch disease, or toxoplasmosis can cause lymphadenopathy with focal cortical thickening due to the inflammatory response.
Do Not Miss Diagnoses
- Malignant Lymphoma with Specific Subtypes: Certain aggressive subtypes of lymphoma, such as diffuse large B-cell lymphoma, can present with rapidly enlarging lymph nodes and significant cortical thickening. Missing these diagnoses can lead to delayed treatment and poor outcomes.
- Metastasis from Aggressive Primary Tumors: Tumors like melanoma, breast cancer, or lung cancer can metastasize to lymph nodes and cause significant enlargement and cortical thickening. Early detection is crucial for treatment planning.
Rare Diagnoses
- Castleman Disease: A rare disorder that can cause lymph node enlargement and cortical thickening, often presenting as a solitary mass. It can be associated with HIV infection or be part of a multicentric form.
- Kikuchi-Fujimoto Disease: A rare, self-limiting condition that causes lymphadenopathy, often with cortical thickening, and is more common in young women. It can mimic lymphoma or tuberculosis clinically and radiologically.
- Kimura Disease: A chronic inflammatory disorder that can cause lymphadenopathy and eosinophilia, with potential for cortical thickening in affected lymph nodes. It is rare and more commonly seen in Asian males.