The ongoing problem with peripheral lymphadenopathies: which ones are malignant?

Peripheral lymphadenopathy is frequently encountered in children, but it is difficult to determine the etiology. Our aim in this study was to evaluate the risk of malignancy in childhood peripheral lymphadenopathy, determine the factors accompanying a malignant etiology and find out which additional findings strongly indicate malignancy.

Patients from whom a peripheral lymphadenopathy biopsy had been obtained between January 2005 and December 2007 were retrospectively reviewed. The patients were divided into two groups as malignant and benign.

There were 32 patients in the malignant group and 52 in the benign group. The mean age was higher (P < 0.001), lymphadenopathy duration shorter (P = 0.007) and lymphadenopathy size larger (P = 0.019) in the malignant group. The incidence of malignancy was higher in supraclavicular and axillary lymphadenopathies. Hodgkin's disease was the most common disease in the malignant group, while it was reactive lymphoid hyperplasia in the benign group. The biopsy result was malignant in 58.3% of abdominal and 60% of mediastinal lymphadenopathy cases. The best indicator for malignancy was a hypoactive spleen nodule.

Increased patient age, supraclavicular lymphadenopathy localization, presence of abdominal or mediastinal lymphadenopathy and especially a hypoactive spleen nodule increase the risk of malignancy.