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Published on: January 12, 2017
A retrospective evaluation of lymphadenopathy in children in a single center's experience
Sevgi Buyukbese Sarsu1, Kamil Sahin2
1Department of Paediatric Surgery, Gaziantep Children's Hospital, Gaziantep, Turkey.
Insights
Infections are the most common cause of pediatric lymphadenopathy, but it is crucial to rule out malignancy, such as non-Hodgkin lymphoma. Biopsies remain the gold standard for diagnosing these conditions.
Area of Science:
- Pediatric Infectious Diseases
- Pediatric Oncology
- Pediatric Pathology
Background:
- Lymphadenopathy is a common presentation in children, with diverse underlying etiologies.
- Differentiating between infectious and malignant causes is critical for appropriate management.
- Regional variations in disease prevalence may influence diagnostic approaches.
Purpose of the Study:
- To identify the causes of lymphadenopathy in children within a specific region.
- To determine the frequency of malignant diseases presenting as lymphadenopathy in pediatric patients.
- To evaluate diagnostic methods for pediatric lymphadenopathy.
Main Methods:
- Retrospective analysis of 1700 children referred for lymphadenopathy between January 2012 and January 2015.
- Evaluation of demographic data, lymph node characteristics, laboratory tests, viral serologies, ultrasonography, and histopathology.
- Biopsy and histological examination for definitive diagnosis in a subset of patients.
Main Results:
- The study included 1003 boys and 697 girls. Bilateral lymphadenopathy was more common (91.9%) than unilateral (8.68%).
- Benign etiologies accounted for 455 cases, while 40 cases were malignant.
- Histological evaluation identified various infections (e.g., tuberculosis, toxoplasmosis), inflammatory conditions (e.g., Kawasaki syndrome, sarcoidosis), and malignancies (e.g., non-Hodgkin lymphoma, Hodgkin lymphoma). Nonspecific changes were noted in 110 cases. Ultrasonography and clinical evaluation aided diagnosis in 1205 patients.
Conclusions:
- Infections, particularly viral and bacterial, are the most frequent causes of pediatric lymphadenopathy.
- Malignant diseases, notably non-Hodgkin lymphoma, require prompt detection.
- Excisional biopsy remains the gold standard for diagnosis, and the observed malignancy rate may be influenced by patient referral patterns.
Objective:
To determine the causes of lymphadenopathies in children living in our region, and detect the frequency of malignant disease.
Methods:
Our study evaluated demographic characteristics, lymph node involvement sites, tests, and viral serologiesperformed to search for the presence of infection, and ultrasonographic, and histologic findings of 1700 children who were referred to the outpatient clinics of the Paediatric Diseases and Paediatric Surgery between January 2012, and January 2015.
Results:
Our study population consisted of 1003 (59 %) boys, and 697 (41 %) girls aged less than 18 years.Definitive diagnosis of43 (8.68 %) patients with unilateral, and 452 (91.9 %) cases with bilateral lymphadenopathies was established. These cases had benign (n=455) , and malignant (n=40) etiologies. Two hundred and four (12 %) of them underwent biopsies. On histological evaluation TB (n=6), Kawasakisyndrome (n=3), catscratch syndrome (n=4), toxoplasmosis (n=17), sarcoidosis (n=22), non-Hodgkinlymphoma (n=23),Hodgkin lymphoma (n=15), and Langerhans cell histiocytosis (n=2) were detected. Histological examination of the biopsy specimens of 110 cases revealed nonspecific histological changes. A total of 1205 (70.88%) patients without definitive diagnosis had undergone ultrasonographic assessments, and clinical evaluations performed before or within 4 weeks after antibiotic therapy and revealed regression of the lesions.
Conclusions:
The most widely encountered cause of lymphadenopathy is infection. Most of them are secondary to nonspecific viral, and bacterial infections. Most frequently diagnosed viral infections are caused by cytomegalovirus (CMV), and Ebstein-Barr virus (EBV). The most important issue in patients presenting with complaints of lymphadenopathy is the detection of the underlying malignant disease (if any), with the most frequent being non-Hodgkin lymphoma. Excisional biopsy is still the gold standard diagnostic method. Although our hospital was not an oncology center, our malignancy rate was higher than seen in some series. This might be possibly due to referral of monitored patients to our regional hospital for biopsy.
