Description

A 60-year-old man presented with bilateral groin swelling for 1 year. Sequentially, he developed similar swellings in the cervical and axillary regions. He noted multiple nodular swellings arranged on the medial aspect of both arms in a linear fashion. At this moment, he reported to our hospital. He had generalised lymphadenopathy and the most characteristic finding was enlarged, bilateral, firm, epitrochlear lymph nodes (figure 1). No finding of local temperature rise, redness or infection was found. He also had hepatosplenomegaly. An excisional biopsy revealed mantle cell lymphoma. Bone marrow aspiration done for staging showed infiltration by mantle cells.

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Figure 1

Clinical photograph showing bilateral epitrochlear lymphadenopathy.

Epitrochlear lymph nodes are present on the medial aspect of the arm, about 1–2 cm above the elbow joint anterior to the medial intermuscular septum between the biceps and triceps.1 Their enlargement is usually a part of generalised lymphadenopathy and sometimes because of pathologies in the hand and forearm. One study from the University of Edinburgh showed no palpable lymph nodes in 140 healthy individuals but nodes were palpable in 27% of 184 patients who were diagnosed with disease causing generalised lymphadenopathy.2 Enlargement of epitrochlear lymph nodes is almost always pathological. Isolated enlargement of epitrochlear lymph nodes has also been reported.3 They can be enlarged in infectious conditions like HIV, leishmaniasis, syphilis, leprosy, cat scratch disease, tuberculosis, filariasis and inflammatory conditions like rheumatoid arthritis when the disease is active in the hands. Their enlargement is much more common in chronic lymphoproliferative disorders than in aggressive lymphomas.