Lymphadenopathy in a Series of Egyptian Pediatric Patients and the Role of Pathology in the Diagnostic Workup

Abstract

Assessment of lymphadenopathy in children represents a diagnostic challenge because of the extensive differential diagnoses, including reactive and malignant conditions. Knowledge of the etiologic pattern of lymphadenopathy in a given geographical region is essential for making a confident diagnosis or for suspecting a disease. Hence, the present study was carried out to identify different etiologies of lymphadenopathy in children in our region and to assess parameters commonly associated with malignancy, with an emphasis on the role of pathology. One hundred and twenty patients aged 1 month to 18 years were included in the study. They were sorted into neoplastic and nonneoplastic (infectious and noninfectious) groups. In 56 patients, biopsy (fine needle aspiration cytology [FNAC], core needle, or excision biopsy) was essential to reach the final diagnosis. Sensitivity of FNAC in the differentiation between neoplastic and nonneoplastic lymphadenopathy was 92.3%, and specificity was 90.0%, with a diagnostic accuracy of 91.3%. We concluded that malignancy should be suspected in the following conditions: presence of abdominal or multiple symptoms; symptom duration of 1-6 months; generalized lymphadenopathy; multiple groups of lymph node (LN) involved; LN size > 2 cm; amalgamated, hard, fixed, and nontender LNs; certain abnormal complete blood count findings; blast cells in blood film; and elevated lactate dehydrogenase level. In such cases, LN biopsy is highly recommended. A final diagnosis was achieved after integrating information from history and clinical findings with the laboratory, radiological, pathological, and microbiological findings. Accordingly, an algorithm for primary diagnostic evaluation of children with lymphadenopathy is suggested.

An insight on pediatric peripheral Lymphadenopathy: Atwo year cytological study in a tertiary care hospital

“…In this study we have presented our experience with 543 cases of pediatric lymphadenopathy over two years. The pattern of the lesions, with benign diagnoses being 97.60% and malignant cases of 2.4%, is similar to the incidence reported in other studies [4,7,[9][10]. In childhood the peripheral lymph nodes usually enlarge due to local inflammatory process [11].…”

“…Fine needle aspiration cytology (FNAC) of enlarged lymph nodes is a wellestablished first line diagnostic test in adult population [2]. In the pediatric population, however, the use of FNAC has met with some resistance and it is not well documented in the literature, with most literature describing only cervical group of lymphnodes [3][4][5][6][7][8]. In children with lymphadenopathy, clinical evaluation and radiological studies are done to assess the patient.…”

Differentiation of benign from malignant cervical lymphadenopathy by ultrasonography in children

“…3 In contrast to these results, Gwili et al, showed that 81 % of the children with benign LAP and 92.7 % of malignant LAP showed bilateral involvement. 11 In our study, 69.8 % of the children with benign LAP showed unilateral involvement whereas 30.2 % of them presented with bilateral and in malignant group, unilateral/bilateral ratio was 93.2 %/6.8 %. We thought that the case selection and study design may be the reason of this discrepancy.…”

Etiologies of Pediatric Cervical Lymphadenopathy: A Systematic Review of 2687 Subjects

“…The 7 studies selected for this review are summarized in Table 1. [5][6][7][8][9][10][11] These studies ranged in size from 49 to 1700 subjects and had a combined total of 2687 children. The subjects represent a global pediatric population from Nigeria, Turkey, Italy, India, and Egypt.…”