Periadenitis

PERIADENITIS, periadenitis (from Greek peri- around, about and aden- gland), inflammation of the gland capsule and adjacent connective tissue. Usually this term is applied to lymph glands (implying perilymphadenitis) and very rarely to true glands, namely the small glands of mucous membranes and skin that have no special names, whereas lesions of the capsules of large glands are designated by the names corresponding to these glands (e.g., perihapatitis, perinephritis, periooophoritis, etc.).-The pathological picture and consequences of P. are entirely determined by the nature of the process in the gland itself. Thus, in acute non-suppurative adenitis, hyperemia, inflammatory edema, infiltration, and often hemorrhages are usually found in the capsule and adjacent connective tissue, and the intensity of each of these signs can vary greatly depending on the etiology of the process. In some cases (as for example in the cervical glands and connective tissue in diphtheria of the throat, in the area of regional lymph glands in anthrax carbuncle), serous impregnation of the tissue (sometimes with an admixture of fibrin) comes to the forefront. In particularly toxic forms of diphtheria, as well as in bubonic plague, glanders, one of the most prominent symptoms of P. is extensive and numerous hemorrhages. In a markedly necrotic process in the glands (for example in the cervical lymph glands in scarlet fever), cellular infiltration sometimes predominates in the tissues surrounding the glands, followed by rapid total necrosis, giving the picture of the so-called phlegmon. The development of purulent foci in the glands (most commonly observed in the cervical lymph glands in scarlet fever and in the inguinal glands in soft chancre) is in turn often accompanied by the spread of suppuration to the capsule and adjacent connective tissue. If such a purulent P. develops around the entire circumference of the gland, the latter becomes completely sequestered from the surrounding tissue, and, being deprived of nutrition, dies completely. With more extensive spread of the process to the surrounding connective tissue, muscles, etc., one speaks of adenophlegmon. Chronic adenitis, like acute ones, are very frequently accompanied by changes in the capsule and tissues adjacent to it. In this case, non-specific forms of gland inflammation (for example, inguinal lymphadenitis in leg ulcer, bronchial in chronic pneumonias and pneumoconioses) usually cause in the surrounding area the development of a slowly proliferative process, having no characteristic features and over time leading to the fusion of the affected gland with adjacent glands, connective tissue, or other organs. If in a gland fused with some dense organ (blood vessel, trachea, esophagus, or as sometimes happens with both of these simultaneously), further softening or secondary suppuration develops, then in case the process spreads to the corresponding part of the capsule, emptying of the gland contents into this organ or the formation of a communication between two organs (for example, the trachea and esophagus) may occur with all the resulting consequences (embolism of vessels, metastatic abscesses, atelectasis of the lungs, suppuration or gangrene of the lungs due to the entry of food particles, etc.). As for specific lesions of the glands (tuberculosis, syphilis, etc.), they can cause changes in the surrounding tissues of two kinds: 1) a non-specific proliferative process, differing in no way from the one just described and developing in the so-called perifocal (collateral) inflammation, and 2) specific changes, quite similar to the changes in the gland itself, with the morphological picture and outcome characteristic of this infection. Processes of the first kind arise in some infections (e.g., tuberculosis) more often and earlier, in others (e.g., lymphogranulomatosis) less often and later, and usually lead to the fusion of glands with each other and with surrounding tissues, sometimes forming voluminous, dense, immovable packets of glands, so characteristic for example of tuberculosis. If non-specific changes are later joined by specific ones accompanied by disintegration and softening of tissue (e.g., caseous necrosis), then in case of preliminary fusion of the gland with a hollow organ (blood vessel, bronchus, etc.), the entry of contents into the corresponding cavity with more or less extensive and rapid spread of the process may also occur. As a typical example of such spread, one can cite the so-called bronchogenous and hematogenous generalizations of tuberculosis, which very often have exactly this origin.