Diagnostic aspects of cervical lymphadenopathy in children in the developing world: a study of 1,877 surgical specimens

Abstract

Chronic cervical lymphadenopathy is a common clinical problem frequently requiring surgical biopsy. To evaluate the characteristics of surgically excised cervical lymph nodes (LN) in children in a developing country, we studied 1,332 children less than 15 years old (1,877 surgically removed cervical LNs) over a 23-year period (1976-1999). Indications for biopsy included failure to respond to antibiotic therapy, rapid increase in size, hard, matted LNs in the preauricular, supraclavicular, and posterior triangle of the neck, and difficulty in diagnosis. Clinical and pathological characteristics investigated included age, malignancy, and granulomatous disease such as tuberculosis (tbc). The mean age was 7 years (tbc 5.8/neoplastic disease 8.5 years). Twenty LNs (1.5%) were histologically normal. There were 637 (47.8%) with nonspecific reactive lymphoid hyperplasia and 484 with chronic granulomatous changes (36.3%). Tuberculous lymphadenitis was confirmed in 332 of these (25%). In 181 (54.5%) Mycobacterium tuberculosis was cultured and a further 149 had acid-fast bacilli. Other granulomatous diseases identified included sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfmann disease) (3), syphilis (4), yaws (2), and toxoplasmosis (1). No mycobacteria other than M. tuberculosis were encountered. More than two-thirds (108) of 154 patients with neoplastic LN involvement had a lymphoma; in a further 10 lymphadenopathy was associated with leukemia. Pyogenic organisms were identified in 32, and 5 were positive for human immunodeficiency virus, 1 of whom had Kaposi's sarcoma. A second pathology was identified in 18 of the 637 cases of reactive lymphoid hyperplasia (3 with tuberculosis); in 15 (1.3%) a diagnosis of lymphoma was made from other sites (pleural fluid, etc.) within 6 months of initial biopsy. This represents a diagnostically difficult subgroup requiring further investigation. Chronic lymphadenopathy in children in developing countries has a high incidence of infective causes, including a significant incidence of M. tuberculosis. The incidence of serious pathology in more than one-half of the cervical LNs examined justifies aggressive surgical investigation.

A Descriptive Study of Histopathological Patterns of Lymph Node Biopsies In A Tertiary Care Hospital

“…This may be due to reactive hyperplasia in lymph nodes draining the site of malignant lesion, which do not shows metastatic deposit due to early diagnosis and surgical excision. This was consistent with study of Moore SW et al found 47.8% 0f reactive lesions [3].…”

Spectrum of pathologic lesions in superficial lymph node biopsies –a one and half year study

“…Though fine needle aspi ration cytology is commonly used to establish the etiological diagnosis, excision biopsy and histopathology of the lymph node remains the "gold standard" for diagnosis 2,3,4 of lymphadenopathy. In our study males were more commonly affected than females.…”

Benign lymphadenopathies

“…These changes may be particularly marked in younger individuals, but may be observed in all ages. [1][2][3] The most important consideration in assessing a reactive lymph node is in its distinction from a neoplasm, mainly the various types of malignant lymphoma. In a minority of circumstances, the specific pattern of reaction may strongly suggest a specific etiology.…”