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Diagnostic aspects of cervical lymphadenopathy in children in the developing world: a study of 1,877 surgical
S W Moore1, J W Schneider, H S Schaaf
1Department of Paediatric Surgery, University of Stellenbosch, Cape Town, South Africa. swm@sun.ac.za
Insights
In developing countries, chronic cervical lymphadenopathy in children often stems from infections like tuberculosis (TB). Surgical biopsy is crucial for diagnosing serious conditions, including lymphoma and leukemia, in pediatric patients.
Area of Science:
- Pediatric Pathology
- Infectious Diseases
- Surgical Oncology
Background:
- Chronic cervical lymphadenopathy is a common pediatric concern, frequently necessitating surgical biopsy for diagnosis.
- Developing countries face unique challenges in managing pediatric lymphadenopathy due to prevalent infectious diseases.
Purpose of the Study:
- To characterize surgically excised cervical lymph nodes (LNs) in children in a developing country.
- To identify the spectrum of diseases, particularly infectious and neoplastic, causing chronic lymphadenopathy in this population.
Main Methods:
- Retrospective analysis of 1,877 surgically removed cervical LNs from 1,332 children (<15 years) over 23 years (1976-1999).
- Investigation of clinical and pathological features, including age, malignancy, granulomatous disease (e.g., tuberculosis), and microbial cultures.
Main Results:
- Histologically normal LNs were rare (1.5%).
- Nonspecific reactive lymphoid hyperplasia (47.8%) and chronic granulomatous changes (36.3%) were common.
- Tuberculous lymphadenitis was confirmed in 25% of cases, with Mycobacterium tuberculosis cultured in many.
- Neoplastic involvement (11.4%) included lymphoma (predominant) and leukemia.
- Other infections like syphilis and toxoplasmosis were identified, alongside HIV co-infections.
Conclusions:
- Chronic pediatric cervical lymphadenopathy in developing nations has a high incidence of infectious etiologies, notably tuberculosis.
- A significant proportion of cases reveal serious pathologies, including malignancy, underscoring the need for aggressive surgical investigation.
- Diagnostic challenges exist, particularly in cases of reactive hyperplasia with potential for later diagnosis of lymphoma.
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.
