Background: Although lymphadenopathy is a common presentation in clinical practice and no previous work was done in this region to assess it, this study was aimed to determine its causes and distribution among adult patients and highlight the gender, age, nationality of patients, number of enlarged lymph nodes and the commonest site of biopsies. Methods: Retrospectively data from lymph node biopsy specimens received at histopathology laboratory, King Khalid Hospital, Majmaah province, Saudi Arabia from January 2009 to December 2013 was reviewed and analyzed using SPSS version 21 software. Results: Of 54 cases of lymph node biopsies received, 28 (51.9%) were males and 26 (48.1%) were females giving male: female ratio 1.1: 1. The age of the patients ranged from 15 to 90 years. The commonest site of biopsies was cervical (61.1%) followed by mesenteric (20.4%) and axillary (11%). The benign pattern was observed in (72.2%) of cases while the malignant was observed in (27.8%) of cases. Malignant pattern was noticed more in elderly peoples with male predominance (60%). Reactive lymphoid hyperplasia (31.5%), tuberculous lymphadenitis (27.8%), Hodgkin`s lymphoma (13%) were the commonest causes of lymphadenopathy. Conclusions: Among the received cases of lymphadenopathy reactive lymphoid hyperplasia was found to be the most common cause followed by tuberculous lymphadenitis and hodgkin's lymphoma.