Cause Of Lymphadenopathy In Children Research Articles

Neinfektivna unilateralna cervikalna limfadenopatija u djece - prikaz pacijenata

Cervical lymphadenopathy in children is often the reason to seek medical attention. According to the literature, 90% of children aged 4-9 years has cervical lymphadenopathy, mainly caused by acute infections, that is treated in the out-of-hospital setting. In a small, but significant number of cases, cervical lymphadenopathy is caused by malignancy and wide range of other clinical entities, that require more detailed clinical approach. Three patients with non-infectous unilateral cervical lymphadenopathy are presented; adolescent boy with unicentric Castleman disease, young adult with progressive transformation of germinal centers, and an infant with viral parotitis mistaken for cervical lymphadenopathy. Unicentric Castleman disease was diagnosed by pathohistological assesment of excised lymph node to a 14-year-old boy after 7 months of persistent cervical lymphadenopathy, and close follow-up was suggested as no disease progression was verified by PETCT. Histopathological-clinical diagnosis of progressive transformation of germinal centers was established in an adolescent with 3-month history of lymphadenopathy, after extensive radiological and infectious assesment. Chronic reccurent course of the disease was once again confirmed, as this patient awaits his third extirpation in the last year. Viral parotitis is one of the conditions that can mimic cervical lymphadenopathy as showed with the third presented patient – a 6-month-old male infant with the submandibular swelling lasting for three days. This article emphasises the importance of a detailed history taking and clinical assesment, but is also a reminder of a less often, noninfectious causes of lymphadenopathy in children, where systematic approach is the key to a correct diagnosis and treatment.

Etiology of Childhood Lymphadenopathy: A Report by a Single-center (2016-2018)

Background: Lymphadenopathy is an enlargement of a lymph node. Pathologic Lymphadenopathy is when there is a symptom of infectious and noninfectious abnormalities or malignant diseases. Most Lymphadenopathies are benign and are associated with a short period of symptoms. Concerning diagnosis and management of adenopathy, especially in the case of children, research is still underway. For this reason, our study investigated and analyzed the causes of lymphadenopathy in children.
 Materials and Methods: This is a retrospective study conducted at the Pediatric Department of children's medical center of Tehran University of medical science. In this study, 130 children with cervical lymphadenopathy aged under 12 years underwent lymph node biopsy. Then under general anesthesia and evaluation of a senior pathologist, the lymph node was excised and biopsied.
 Results: During the study, twenty-five cases were excluded. Fifty-three patients (50.47%) demonstrated infection history, 22 cases (21%) had neoplasia, and reactive inflammatory changes with nonspecific origin were seen in 42 cases (40.0%). We observed chronic lymphadenitis in 3(2.9%) cases, and finally, 1(1.0%) case was metastatic. Mean lymph node size proved to be greater than two cm in metastatic (2.22cm), lymphoma (2.33cm), and granulomatous (3.17cm) lymphadenopathies. The average lymph node size turned out to be 1.53 cm in reactive lymph nodes (P =0.021). The diagnosis was obtained by excisional biopsy and histopathology.
 Conclusion: Acute infections are the most common reason for lymphadenopathy in pediatric conditions. It is better to be suspicious of malignancy with a high index in cases of cervical lymphadenopathy, especially if the lymph node size is higher than 2 cm. History, clinical features, and paraclinical tests can be used for lymphadenopathy in children.

Evaluation of paediatric lymphadenopathy at a rural tertiary care centre

Background: The aim and objectives of the present study was to determine the various etiologies of lymphadenopathy in children in our region and its associated clinical findings and prevalence of malignancy in children presented with significant lymphadenopathy.Methods: Sixty-five patients with significant lymphadenopathy charts were reviewed retrospectively from department of Paediatrics and Paediatric Surgery during the period of September 2018-2020. Patient’s records were evaluated in terms of age, gender, complaints, and characteristics of lymph nodes in terms of site, consistency, discharge, sinus and clinical course of a patient. Physical findings of all the cases were noted. Hematological and serological tests were done to know the source of infection. Clinical findings and laboratory results were corroborated with pathological diagnostic tests like FNAC and Excision biopsies in children with significant lymphadenopathyResults: The etiology was confirmed in 94% children and couldn’t be diagnosed in 6% children presented with significant lymphadenopathy. On evaluation commonest etiology was infection with reactive hyperplasia in 58% of children secondary to bacterial or viral infections, Kawasaki disease, suppurative lymphadenitis in 17%, tuberculous lymphadenitis in 14%, and malignancy in 11%. Majority of children presented with cervical lymphadenopathy. An unusual presentation of Non Hodgkin lymphoma as intestinal obstruction with no significant mass per abdomen, a case of nasopharyngeal carcinoma presented as torticollis due to massive unilateral cervical lymphadenopathy were diagnosedConclusions: The most widely encountered cause of lymphadenopathy in children was infection. Most of them are secondary to non specific viral or bacterial infections. The most important concern in children presenting with complaints of lymphadenopathy is the detection of underlying malignant disease. There was significant malignancy rate in our study in children with lymphadenopathy with few atypical presentations. Excisional biopsy is the gold standard method to confirm the diagnosis.

Lymph node biopsy in children: Indications and etiology

Background: Peripheral lymphadenopathy manifests in a variety of benign and malignant conditions and is often challenging to distinguish pathologic from non-pathologic etiology based on clinical presentation alone. Therefore, lymph node biopsy is often required as an essential part of management. This study aimed to determine the causes of peripheral lymphadenopathy in children needing excision biopsy in our setting and establish a correlation with clinical features and laboratory findings. Methods: A retrospective review of medical records of children aged 0-14 years undergoing lymph node biopsy at our institution, between January 2015 and June 2018, was conducted. Demographic, microbio­logical, and histopathological findings were reviewed. Results: A total of 69 patients underwent lymph node biopsy, the majority of whom were male (n=40, 58%), with a mean age of 7.9 years. The histopathological findings confirmed lymphoma (n=27), tubercu­losis (n=24), benign reactive changes (n=14), and Langerhan Cell Histiocytosis (n=4). Cervical lymph nodes were most frequently involved (n=64). Associated symptoms included fever (n= 27), weight loss (n=2) and cough (n=7). Only one patient developed a postoperative complication (wound infection). A clini­cal diagnosis of tuberculosis (TB) had been presumed in 19 patients, but only 2 (11%) were confirmed to have TB, whereas10 were found to have histopathological findings of lymphoma. Conclusion: Excisional biopsy is useful in the management of children with lymphadenopathy, allowing treatment to be initiated based on a histopathological diagnosis.

Clinical and laboratory evaluation of lymphadenopathy in particular with fine needle aspiration cytology

Background: To know the various causes of lymphadenopathy in children and to know the usefulness of FNAC in diagnosis of various causes of lymphadenopathy.Methods: Children less than 12 years with significant lymphadenopathy (lymphadenopathy of >1 cm in cervical, axillary and >1.5 cm in inguinal region) were included.Results: A total of 50 children were enrolled in the study. The incidence of lymphadenopathy was more common in the age group of 4-8 year during the lymphoid phase with male preponderance of all the causes infections especially tuberculosis was the major cause of lymphadenopathy which is totally preventable by giving BCG vaccination. The sensitivity of FNAC in the present study was 71.3%. In 3 cases FNAC 69 was not done because peripheral smear examination revealed that the patients are suffering from acute lymphoblastic leukemia.Conclusions: FNAC is a simple bed side investigation though traumatic is of immense value for diagnosing various cases. Even though it may not be a replacement for lymphnode biopsy, it is preferred as a first line investigation because of its simple procedure.

Usefulness of fine needle aspiration cytology in diagnosis of causes of lymphadenopathy in children

Background: The present study was conducted to study the causes of lymphadenopathy, associated clinical findings, usefulness of FNAC in diagnosis of various causes of lymphadenopathy as lymph node biopsy is a difficult and invasive procedure in children attending pediatric department.Methods: A study was done at Katuri medical college and hospital. A total of 50 patients with lymphadenopathy including both local and generalized were studied for a period of 2 years by taking proper history, through physical examination both generalized and systemic and all the patients were subjected for relevant investigations for establishment of diagnosis which is essential for institution of proper treatment. A prospective study consisting 50 patients with lymphadenopathy (<12year) is undertaken to find the incidence of various causes of lymphadenopathy in the affected patients for 2 year.Results: It was observed that 10, 17 and 23 children were having lymphadenopathy in the age groups of 0-3-year, 4-8 year and 9-12 year respectively. Majority of patients were having lymphadenopathy only after 4 year of age, male 28 and female 22. The major symptoms in order of incidence were palpable swelling, fever, cough, weight loss, loss of appetite and sore throat. Duration of lymphadenopathy of less than 1 month was seen in 25 cases ,1-6 months 24 cases and more than 6 months in 1 case. Enlargement of lymph nodes in cervical region, was the major finding in these patients. 47 cases were having local lymphadenopathy mainly in the cervical region and 3 cases were having generalized lymphadenopathy. 80% of the patients were having firm lymph nodes, remaining 20% of the patients were having soft lymphadenopathy. 36 patients were having mobile lymph nodes while 14 patients were having matted lymph nodes. Tenderness was observed in 21 cases against absence of tenderness in 29 cases. Analysis of the FNAC results revealed positive for tuberculosis in 11 cases reactive hyperplasia in 26 cases, granulomatous changes seen in 4 cases and suppurative lymphadenitis in 6 cases.Conclusions: In developing countries like India whenever a patient attends the Department of Paediatrics with lymphadenopathy it is always be prudent to exclude tuberculosis, which is quite prevalent. FNAC is helpful in those with benign conditions like reactive hyperplasia to rule out underlying serious systemic diseases and reassuring the parents.

La maladie de Kikuchi-Fujimoto ; un diagnostic différentiel méconnu du lymphome chez l’adolescent

Kikuchi-Fujimoto disease, also known as histiocytic necrotizing lymphadenitis, is a rare cause of lymphadenopathy in children. This benign disease can mimic lymphoma and misleads doctors. It was first described in Asia, where it occurred especially in young women. Recent publications show that it can also affect teenagers and young adults in Caucasian populations. The pathophysiology remains unknown. Three hypotheses have been raised for this disease: the role of viruses (in particular HHV-8), genetic predisposition (two alleles in HLA class II geneswere found more frequently in patients with Kikuchi disease), and an autoimmune cause because of the correlation with lupus erythematosus. Few cases have been reported in Europe so far. In this article, we report three cases of Kikuchi disease observed in less than 2 months in a single hospital in France. All three patients were teenagers who presented with lymphadenopathy, either isolated or combined with fever, weakness, and weight loss. In all of them, the hypermetabolic activity of the lymph node on the PET scanner misled us to suspect lymphoma. The diagnosis of Kikuchi disease was finally made, for all patients, after 2 weeks in the hospital based on lymph node biopsy. Based on this report, we highlight that early biopsy in presence of lymphadenopathy can avoid unnecessary extensive investigations. Moreover, in this rare disease, it is very surprising to come across three cases that are not family-related, in such a short period of time. This strengthens the hypothesis of the possible implication of an environmental factor in the pathophysiology of Kikuchi disease.

A Study to Correlate between FNAC and Histopathological Diagnosis of Enlarged Lymph Node

Background: Aspiration of enlarged lymph node is commonly done. Although open biopsy with histopathological examination of tissue still remains the gold standard yet F.N.A.C. is an integral part of initial diagnosis. Objective: To highlight the role of F.N.A.C. in the diagnosis of etiological profile of lymphadenopathy and to find out the accuracy of F.N.A.C. in comparison to histopathological diagnosis. Methods: The prospective study was done for two years. The results of lymph node F.N.A.C. were compared and evaluated taking histopathology as gold standard. Results: Cervical lymph node were most commonly involved. Most common cause of lymphadenopathy in children was reactive hyperplasia and tuberculosis in adults.Conclusion: The sensitivity and diagnostic accuracy of F.N.A.C. results were high when compared with histopathological findings.

Características clínicas e histológicas de adenopatías en pacientes pediátricos

BackgroundLymphadenopathy is a common cause for medical consultation in the child population, accounting for up to 44% in children under 5 years old. In some cases, it is required to take lymph node biopsy specimens in order to clarify the diagnosis. ObjectiveTo describe the clinical and histological features of paediatric patients with lymphadenopathy and lymph node biopsies. Patients and methodDescriptive and retrospective study conducted in Medellin (Colombia) in a fourth-level hospital between January 1st of 2009 and December 31st of 2012. In the study, lymph node biopsy specimens were taken from children under 15 years old. Demographic, clinical and laboratory features, and characteristics of the patients were evaluated, as well as the histopathological diagnosis of the lymph node biopsies. ResultsFrom the child population, 61 children met the eligibility criteria and 33 (54.1%) of them were male with an average age of 6 years old. The most common pathological diagnoses in the study group were as follows: reactive hyperplasia (50.8%), neoplasms (27.9%), chronic granulomatous disease (4.9%), and bacterial infection (3.3%). It could be concluded from the findings in the study that Hodgkin lymphoma is very common among the neoplastic diseases, with 18%, and the most frequent location was the neck with 60.6%. ConclusionsThis study demonstrates the importance of performing a differential diagnosis when approaching patients with lymphadenopathy. As reported in the world medical literature, benign origin is the most common cause of lymphadenopathy in children.

English

BACKGROUND: Lymphadenopathy is one of the commonest clinical presentation among the children (0-14years) having several etiologies and can pose a diagnostic dilemma to a pediatrician. FNAC is an important and rapid diagnostic modality for the etiologic workup in significant lymphadenopathy. AIMS AND OBJECTIVES: To know the incidence of various causes of lymphadenopathy in children. To know the advantages of FNAC over surgical biopsy. MATERIALS AND METHODS: The present study comprises of FNAC of lymph nodes of 120 cases in pediatric age between 0-14years with lymphadenopathy, who attended the OPD and those admitted in Khaja Banda Nawaz Teaching and General Hospital, Gulbarga during the period between JAN 2013 to DEC 2014. Detailed history and thorough clinical examination and routine examination was done on approach of the patient. FNAC was carried out in all cases on significant lymph nodes and aspirated materials was smeared and sent to laboratory various stains were used for staining cytological smears. RESULTS: Over all lymphadenopathy was common in (5-10years) age (35%), higher in males (54.1%) than females. Anatomically cervical lymphadenopathy was commonest (90%). Most common cause was found to be TB lymphadenitis. CONCLUSION: FNAC of lymph node in children is simple rapid diagnostic method with minimum discomfort to the patient and readily accepted by

Clinicopathologic Correlation of Epidemiologic and Histopathologic Features of Pediatric Bacterial Lymphadenitis

Infection is a common cause of lymphadenopathy in children and has numerous microbial etiologies. Lymph node biopsy is considered a keystone in arriving at a definite diagnosis. An accurate differential diagnosis from a lymph node biopsy can expedite diagnosis and minimize ancillary testing. To assess and compare the histopathologic and epidemiologic features of common and uncommon pediatric bacterial lymphadenitis. We searched our database for surgical specimens that had a positive identification of bacteria during an 8-year period. The chart was reviewed to assess the pathogen identified and epidemiologic data. The archival tissue sections were reviewed and the histopathologic findings described for each pathogen. The review of 368 pediatric lymph node biopsies identified 33 cases with a bacterial infection. These comprised 21 cases of Mycobacterium avium complex (60%), 1 of Mycobacterium fortuitum (3%), 7 of Bartonella henselae (20%), 2 of Yersinia enterocolitica (7%), 1 of Francisella tularensis (3%) and 1 of Streptococcus pyogenes (3%). Each of these infectious lymphadenitides had distinct epidemiologic and histopathologic features that are discussed in this report.

Kimura’s disease—an unusual cause of lymphadenopathy in children

Kimura's disease is a rare inflammatory disorder of unknown cause primarily seen in young Asian males. The disease is characterized by a triad of painless subcutaneous masses in the head or neck region, blood and tissue eosinophilia, and markedly elevated serum immunoglobulin E levels. We describe a 3-year-old Indian boy with Kimura's disease who presented with generalized lymphadenopathy. The diagnosis was based on the characteristic histopathologic findings after surgical excision in conjunction with peripheral eosinophilia and elevated serum immunoglobulin E levels.