ASSESSMENT OF PERIPHERAL LYMPHADENOPATHIES: Experience at a Pediatric Hematology-Oncology Department in Turkey

Abstract

Since a large variety of disorders may lead to lymph node enlargement determining the cause of peripheral lymphadenopathy (LAP) in children can be difficult. This retrospective study evaluated 200 children who were admitted to an Oncology-Hematology department because of lymphadenopathy and aimed to determine the clinical and laboratory findings that were valuable for differential diagnosis. A specific cause for lymphadenopathy was documented in 93 (46.5%) cases. One hundred forty (70%) children were classified as having a benign cause for lymph node enlargements. Fourteen (10%) of these cases underwent an excisional lymph node biopsy, and histopathological examination showed a reactive hyperplasia. Sixty (30%) cases were classified as having a malignant disease-causing lymphadenopathy. In terms of differential diagnosis, some associated systemic symptoms, physical findings, and laboratory investigations showed significant difference between benign and malignant lymphadenopathy groups. The following findings were determined as being important to alert the physician about the probability of a malignant disorder: location of the lymphadenapathy (supraclavicular and posterior auricular), duration of the lymph node enlargement (>4 weeks), size of the lymph node (>3 cm), abnormal complete blood cell findings, abnormalities in chest X-ray, and abdominal ultrasonography.

Çocukluk Çağında Periferik Lenfadenopatiler: Tek Merkezli Çalışma

“…Karaman et al reported that there is no significant difference between benign and malignant diseases with respect to LAP size similar to our findings 10 . On the other hand Kumral et al reported that LAP larger than 3 cm represent a greater risks for malignancies 5 . Malignant and granulomatous diseases should be considered in patients with hard or mixed LAP, fixed to the surrounding tissue.…”

“…LAP > 2 cm in size are suspicious for malignancies or granulomatous diseases and LAP < 1 cm in size suggest benign diseases 5,7,9 . Karaman et al reported that there is no significant difference between benign and malignant diseases with respect to LAP size similar to our findings 10 .…”

“…Cervical LAP is the most common localization for both benign and malignant diseases 5,6,9,14 . The incidence of malignancy is higher in supraclavicular, infra-cervical, and posterior cervical LAP [5][6][7]9 . Our study also showed that supraclavicular, cervical, and inguinal LAP were significant in the presence of malignant LAP.…”

“…Infections should be considered first in the etiology of cases with peripheral LAP < 2 weeks in duration, and malignancy and granulomatous diseases are suggestive of chronic LAP patients 5,6,9,15 . In the current study, the duration of LAP was longer in malignant LAP group than benign LAP group.…”

Approach to pediatric cervical lymphadenopathy

“…[21] Hasta sevk edilen büyük merkezlerde ve pediatrik hemato-onkoloji merkezlerinde açık biyopsi oranları sıra-sıyla %28 ile %38 arasında değişirken sonuçları malignite gelen biyopsi oranları sırasıyla %23 ile %30'dur. [8,22] Hangi durumlarda açık biyopsiyi düşünmemiz gerektiği şu faktörlerle özetlenebilir: [6,18,19] • Malignite şüphesi • Antibiyotik tedavisine rağmen dört ile altı haftadan uzun süredir devam eden tanı konulamayan lenfadenopati • Lenfadenopati boyutunun iki haftada artış gös-termesi • İki santimetreden büyük lenfadenopati • Supraklaviküler lenfadenopati • Anormal akciğer grafisi • Sistemik belirtiler/malignite düşündüren semptomlar: kilo kaybı hepatosplenomegali, ateş ve eklem ağrıları.…”