Lymphadenopathy In Children Research Articles

Unusual Signal of Lymphadenopathy in Children with Nodular Sclerosing Hodgkin Lymphoma.

The current guidelines for initial cross-sectional imaging in pediatric lymphomas involve computed tomography (CT) of the chest, abdomen, and pelvis. However, whole-body magnetic resonance imaging (MRI) can be favored over CT for diagnosing and staging the disease, given its lack of ionizing radiation and its higher tissue contrast. Imaging characteristics of lymphoid tissue on MRI include a high T2/short tau inversion recovery (STIR) signal. A low or intermediate signal of lymphadenopathy on T2 and STIR images is an unexpected finding, noted anecdotally in nodular sclerosing Hodgkin lymphoma. This signal may be characteristic of a histological subtype of the disease and, if confirmed, could potentially be used to avoid biopsy. In this study, we aimed to review signal characteristics of lymphadenopathy in patients with biopsy-confirmed nodular sclerosing Hodgkin lymphoma. We undertook a retrospective review of relevant MR studies of patients with nodular sclerosing Hodgkin lymphoma. Studies were reviewed by an experienced pediatric radiologist regarding lymph node signal, especially on T2/STIR. Eleven children with nodular sclerosing Hodgkin lymphoma were included. Median age at the time of MRI was 14.3 (IQR: 13.9-16.1) years, and nine were boys. Five patients showed some lymphadenopathy with a low T2/STIR signal, and six showed an intermediate T2/STIR signal. Central gadolinium non-enhancement was observed in four patients. All eleven patients (100%) with a diagnosis of nodular sclerosing Hodgkin lymphoma showed some lymphadenopathy with a low or intermediate T2/STIR signal, and five children (45.5%) showed a frank low signal of some lymphadenopathy, a feature which may prove to be a biomarker for this histology.

Using T2-weighted magnetic resonance imaging-derived radiomics to classify cervical lymphadenopathy in children

BackgroundCervical lymphadenopathy is common in children and has diverse causes varying from benign to malignant, their similar manifestations making differential diagnosis difficult.ObjectiveThis study aimed to investigate whether radiomic models using conventional magnetic resonance imaging (MRI) could classify pediatric cervical lymphadenopathy.MethodsA total of 419 cervical lymph nodes from 146 patients, and encompassing four common etiologies (Kikuchi disease, reactive hyperplasia, suppurative lymphadenitis and malignancy), were randomly divided into training and testing sets in a ratio of 7:3. For each lymph node, 1,218 features were extracted from T2-weighted images. Then, the least absolute shrinkage and selection operator (LASSO) models were used to select the most relevant ones. Two models were built using a support vector machine classifier, one was to classify benign and malignant lymph nodes and the other further distinguished four different diseases. The performance was assessed by receiver operating characteristic curves and decision curve analysis.ResultsBy LASSO, 20 features were selected to construct a model to distinguish benign and malignant lymph nodes, which achieved an area under the curve (AUC) of 0.89 and 0.80 in the training and testing sets, respectively. Sixteen features were selected to construct a model to distinguish four different cervical lymphadenopathies. For each etiology, Kikuchi disease, reactive hyperplasia, suppurative lymphadenitis, and malignancy, an AUC of 0.97, 0.91, 0.88, and 0.87 was achieved in the training set, and an AUC of 0.96, 0.80, 0.82, and 0.82 was achieved in the testing set, respectively.ConclusionMRI-derived radiomic analysis provides a promising non-invasive approach for distinguishing causes of cervical lymphadenopathy in children.Graphical

Evaluation of Peripheral Lymphadenopathies in Children in a Single Center: Predictive Factors for Malignancy.

Lymphadenopathy (LAP) is a common finding in pediatric patients. It was aimed to determine predictive factors in distinguishing cases with malignant or benign lymphadenopathy in this study. Between January 2022 and January 2023, 101 patients (1-16 years old) with lymphadenopathy were retrospectively examined. LAP was localized in 80.2% (n=81) cases and generalized in 19.8% (n=20) cases. In 60 cases (59.4%), lymph node sizes were found to be greater than 20×20 mm in width and length. The most common infectious causative agent was Epstein Barr Virus (EBV). Seven (6.9%) patients underwent biopsy and all were diagnosed with malignancy. When the benign and malignant groups were compared, age, lymph node length, and width on physical examination, anteroposterior and longitudinal diameter of the lymph node on ultrasonography (USG) were statistically significantly higher in the malignant group (p<0.05). The presence of supraclavicular lymphadenopathy was found to be an important factor in differentiating the malignant group (p<0.003). The most important factors in distinguishing the groups are respectively were the anteroposterior diameter of the lymph node on ultrasonography and the presence supraclavicular lymph node in multivariate logistic regression analysis. It is not always easy to distinguish benign and malignant etiologies in patients with lymphadenopathy. A detailed history, a careful physical examination, laboratory studies, and excisional biopsy are guiding.

The Role of Ultrasonography in the Discrimination of Reactive Lymphadenopathy in Children

The Role of Ultrasonography in the Discrimination of Reactive Lymphadenopathy in Children

Association Between Clinical, Laboratory, and Ultrasound Characteristics and Cancer Incidence of Peripheral Lymphadenopathy in Children

Objective: Peripheral lymphadenopathy is very common in childhood. Although they are usually benign, they are often seen in pediatric outpatient clinics because they are a major cause of concern for families. However, physicians cannot afford to overlook the possibility of cancer, which is why many of these patients are referred to pediatric hematology and oncology outpatient clinics. In this study, we calculated the proportion of patients requiring biopsy and the frequency of malignancy, and investigated the characteristics that may be associated with malignancy.

Using T2-Weighted MR Imaging-Derived Radiomics to Classify Cervical Lymphadenopathy in Children

Background: Cervical lymphadenopathy is common in children with diverse causes varying from benign to malignant, their similar manifestations make differential diagnosis difficult. This study intended to investigate whether radiomic models using conventional magnetic resonance imaging (MRI) could classify pediatric cervical lymphadenopathy. Methods: A total of 419 cervical lymph nodes (LNs) from 146 patients, belonging to four common causes (kikuchi disease, reactive hyperplasia, suppurative lymphadenitis and malignancy), were randomly divided into training and testing sets at a ratio of 7:3. For each LN, 1218 features were extracted from T2-weighted images. Then the least absolute shrinkage and selection operator (LASSO) model were used to select the most relevant ones. Two models were built using support vector machine classifier, one was to classify benign and malignant LNs and the other further distinguished four different diseases. The performance was assessed by receiver operating characteristic curves and decision curve analysis. Results: By LASSO, 20 features were selected to construct a model to distinguish benign and malignant LNs, which achieved an area under the curve (AUC) of 0.89 and 0.80 in the training and testing set respectively. Sixteen features were selected to construct a model to distinguish four different cervical lymphadenopathies. For each etiology (kikuchi disease, reactive hyperplasia, suppurative lymphadenitis and malignancy respectively), an AUC of 0.97, 0.91, 0.88 and 0.87 was achieved in the training set, and an AUC of 0.96, 0.80, 0.82 and 0.82 was achieved in the testing set. Conclusion: MRI-derived radiomic analysis provides a promising noninvasive approach for distinguishing cervical lymphadenopathy in children.

Association between the Clinical, Laboratory and Ultrasound Characteristics and the Etiology of Peripheral Lymphadenopathy in Children.

Peripheral lymphadenopathy affects most children at least once in a lifetime and represents a major reason for concern. Therefore, we aimed to identify the most common causes of peripheral lymphadenopathy in hospitalized children and to determine the clinical, laboratory and ultrasound characteristics that enable fast, easy and accurate etiological diagnosis. We performed a cross-sectional study including 139 children who were hospitalized because of peripheral lymphadenopathy. Ultrasound of lymph nodes was performed in 113 (81.3%) patients. Lymphadenopathy was generalized in nine (6.5%) patients. Malignant etiology was established in only three (2.2%) patients. Bacterial lymphadenitis, infectious mononucleosis (IM) and cat scratch disease (CSD) were diagnosed in 66 (47.5%), 31 (22.3%) and 29 (20.9%) patients, respectively. Bacterial lymphadenitis was significantly associated with neutrophilia (p < 0.01), and increased C-reactive protein levels (p < 0.01). IM was associated with pharyngitis (p < 0.01), leukocytosis without neutrophilia (p = 0.03) and increased blood liver enzyme levels (p < 0.01). CSD was associated with recent contact with a cat (p < 0.01), absence of a fever (p < 0.01) and normal white blood cell count (p < 0.01). Thorough history and clinical examination in combination with a few basic laboratory tests enable fast and accurate differentiation between the most common etiologies of lymphadenopathy in children to avoid unnecessary procedures and hospitalizations.

"Truffle sign". A suspicious malignant pattern of lymphadenopathies in children observed on ultrasound. Preliminary study.

The differential diagnosis of lymphadenopathies in children including benign and malignant conditions is often difficult to identify by ultrasound (US). The lymphadenopathies in children are frequent and mostly benign, therefore it is essential to decide what patients should undergo further studies. To describe the potential usefulness of a new suspicious ultrasound sign on pediatric lymphadenopathies that can orient the diagnosis of malignancy. We retrospectively reviewed all pediatric cases with lymphadenopathy suspicious of lymphoma or lymphoproliferative syndrome on soft tissue ultrasound from 2014 to 2021. Two expert ultrasound radiologists reviewed ultrasound images of these patients, associating the internal structure of infiltrated adenopathy with the internal structure of the truffles. On ultrasound, twelve cases presented enlarged lymphadenopathy with loss of internal structure, without hilum; mostly hypoechoic parenchyma, with some fine echogenic serpiginous linear surrounding hypoechoic pseudo nodular images, resembling the inner structure of black truffles. This US pattern looked suspicious and histological study was recommended. In 9 cases a lymphomatous infiltrated adenopathy was confirmed on biopsy. The truffle sign is a new potential suspicious ultrasound sign, that can suggest malignant lymphadenopathy in children. This ultrasound pattern can have some probable usefulness to the radiologist in order to recommend further studies, including histological study, that need to be validated by a larger sample. It is important to recognize easily and early the lymphomatous compromise in a lymph node.

AIUM Practice Parameter for the Performance and Interpretation of Diagnostic Ultrasound of the Thyroid and Extracranial Head and Neck.

AIUM Practice Parameter for the Performance and Interpretation of Diagnostic Ultrasound of the Thyroid and Extracranial Head and Neck.

Detection of the Mycobacterium avium complex in dogs with lymphadenitis.

Mycobacterium avium complex (MAC) is connected to human immunosuppressive diseases, including HIV-AIDS, and may pose a zoonotic threat. MAC causes lymphadenopathy in children, respiratory infection in adults, and generalized infection in immunocompromised individuals. Infection with nontuberculous Mycobacteria (NTM) in humans is now primarily brought on by MAC. Recently, MAC members have emerged as pathogenic organisms for animals and humans. While dogs are generally resistant to mycobacterial infections, there have been some cases of infection that result in systemic or disseminated diseases. The organisms can be transmitted to dogs through oral contact, and their faeces can be a possible source of infection for dog owners. It is important to note that this ailment is zoonotic, especially if infected pet dogs are in prolonged contact with their humans. The study was planned to demonstrate the occurrence of MAC organisms and other Mycobacteria in dogs associated with lymphadenopathy cases with special emphasis on lymphadenitis. A total of 123 samples (100 lymph node aspirates, 15 lymph node tissues, and 8 blood samples) from 83 dogs suspected of lymphadenitis accompanied by gastroenteritis, chronic skin infections, immunosuppression, chronic pulmonary diseases, and other chronic undiagnosed diseases were studied. The samples were processed for cytological and microscopic examination by Ziehl-Neelsen staining. Following the decontamination procedure, the aspiration and lymph node tissue samples were inoculated into Middlebrook 7H11 media for up to 8 weeks. The aspirated material was also directly used for molecular detection by triplex-nested polymerase chain reaction (nPCR) assay. A cytological study revealed pyogranulomatous inflammation of the lymph node tissue. Impression smears from lymph node tissues displayed the presence of acid-fast organisms. Out of 83 cases of dogs, 8 were found to be positive for Mycobacterium spp. Among those 8 positive cases, 3 were confirmed to belong to MAC, and 5 belonged to the Mycobacterium tuberculosis complex (MTB complex). MAC and MTB are the underestimated bacteria that could be the causative agents of lymphadenitis in animals.

Relevance of mesenteric lymphadenopathy in children detected on sonography

Relevance of mesenteric lymphadenopathy in children detected on sonography

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.

“CERVICAL LYMPHADENOPATHY AND ITS ETIOLOGY IN CHILDREN: A STUDY IN A TERTIARY HEALTH CARE INSTITUTE.”

Background: Lymphadenopathy occurs in a number of cases presenting in ENT out-patient department. Most cases are found to have enlarged cervical lymph glands. Lymphadenopathy is a condition affecting the lymph nodes of the body as a result of infection, benign or malignant conditions. As a result, lymph nodes become enlarged and abnormal in size, shape, consistency and they may show xity, abnormal mobility or symptoms that differ from normal. This is due to uid accumulation and action of lymphocytes. The most common form is lymphadenitis when it is due to inammation. Inammation may spread from surrounding soft tissue via lymphatic vessels or direct involvement of the lymph glands. A study was conducted to have an idea about the most common cause of cervical lymphadenopathy in children as most common region of lymph node in children is cervical groups of lymph nodes. A hospital-based prospective study was Methods and Materials: conducted in the department of otorhinolaryngology and head and neck surgery, from a time period of October 2021 to March 2022 and results analysed from the collected data. Results: Reactive lymphadenopathy due to viral or bacterial infections is the leading cause followed by systemic and malignant diseases. Discussion: Inammatory response is the leading cause of cervical lymphadenopathy in children.

ALL-380 Splenomegaly Is an Alarming Sign of Non-Benign Lymphadenopathy in Children Referred to a Tertiary Center

Lymphadenopathy (LN) is a cancer symptom in children; however, most cases are benign. This study aimed to identify risk factors for malignant LN. Differences in LN cases referred to general or pediatric outpatient clinics. All children older than 4 years with LN who were referred to our General Pediatrics or Pediatric Oncology Clinics from 2018 to 2022 were evaluated according to clinical presentation, including complete blood count (CBC), viral serology, bone marrow aspiration, biopsy, and imaging. Of 874 children aged 4-16 years (median 7 years), 56% were boys. LN associated with acute bacterial infections was excluded (n= 412). Among children referred to the General Pediatrics Clinic (n=213), 1.9% of cases were malignant compared with 16% of cases referred to the Pediatric Oncology Clinic (n=249), including acute leukemia (n=24) and lymphoma (n=11) cases. Among malignant cases, 40% were secondary to non-Hodgkin lymphoma (n=4) and cases eventually identified as non-malignant included non-common variable immune deficiency (CVID) hemophagocytic lymphohistiocytosis (n=4), collagen-related lymphoproliferation (n=5), CVID (n=2), and autoimmune lymphoproliferation (n=4). Among those referred to the General Pediatrics Clinic, EBV and CMV were identified in 56% and 22% of cases, respectively, with a male prevalence. No differences in the frequencies of fever, sore throat, bad breath, or respiratory symptomatology were identified between malignant and benign cases. Splenomegaly was more frequently observed in malignant cases, but the difference between groups was not significant. A leukemia diagnosis (defined as associated fever >2 weeks, purpura, bone aches) was more likely (odds ratio 4.5) for generalized LN, characterized as non-regressive, firm, and non-tender, than for non-infectious LN (odds ratio 3.2). The delay in diagnosis ranged from 4 to 47 days (median 19 days). Bone marrow was assessed in 59 cases. The most commonly reported investigations were CBC (100%), EBV or CMV IgM (66%), erythrocyte sedimentation rate (50%), and imaging (local ultrasound in 80%, chest or abdomen CT in 25%, and CT-guided biopsy in 10%). EBV was the most common viral infection. Leukemia was rare in our cohort, and alarming signs included persistent fever >2 weeks, non-regressive bone aches, and splenomegaly.

Unpredicted clinical manifestation of COVID-19: a unique case report and review of literature

BackgroundCervical lymphadenopathy in children is a common problem in daily clinical practice. Many cases of cervical lymphadenopathy after the COVID-19 vaccine were reported. However, there is no yet reporting a case of supraclavicular cervical lymphadenopathy due to COVID-19. Case presentationA 12-year-old girl presented with fever, cough, fatigue, anosmia, and ageusia. COVID-19 was confirmed by real-time PCR. The symptoms were resolved within 10 days. Seven days later, she complained of supraclavicular swelling. Physical examination revealed painless, multiple, and mobile supraclavicular lymph nodes. Ultrasound and fine-needle aspiration cytology were suspicious. Therefore, an excisional biopsy of the largest node was performed. The specimen was sent for histopathology and immunohistochemistry evaluation which confirmed the benign nature of the lymph node.ConclusionTo our best knowledge, this is the first case of supraclavicular lymphadenopathy in a child with COVID-19. It is essential to put COVID-19 in the differential diagnosis of cervical lymphadenopathy.

Flow cytometry assessment of reactive T-cells distinguishes classic Hodgkin lymphoma from benign lymphadenopathy in children.

BackgroundDetection of classic Hodgkin lymphoma (cHL) neoplastic cells using flow cytometric immunophenotyping (FCI) remains limited. We hypothesized that characterization of the reactive infiltrates could assist in diagnosing cHL in children.MethodsFCI using four‐color staining approaches was performed on 156 lymph node specimens with the following histopathologic diagnoses: cHL (25 cases), reactive lymphoid hyperplasia (RLH, 44 cases), and non‐Hodgkin lymphoma (87 cases).ResultsThe overall concordance of FCI data with the histopathologic results of these cases was 81.4%. A reactive expansion of T‐cells with increased expression of CD45RO was present in the reactive infiltrate of cHL (CD45RO/CD3, 67.5%) and Epstein–Barr virus (EBV) infected RLH (62.7%) but not in EBV‐negative RLH (28.0%). The mean fluorescence intensity (MFI) of CD7 was higher for cHL and differed significantly from EBV‐positive RLH (138.5 vs. 63.8). A proposed diagnostic algorithm markedly elevated the overall concordance rate from 81.4% to 97.4%.ConclusionsImmunophenotyping the reactive infiltrate of lymphoid tissue using flow cytometry is a reliable supplement to histopathology for the rapid diagnosis of pediatric cHL.

Not all lymphadenopathy is lymphoma: A case report of Rosai-Dorfman disease

Background: Rosai-Dorfman Disease (RDD) is a rare non-Langerhans cell histiocytic disorder most commonly presenting as bilateral cervical lymphadenopathy in children and young adults. Although a heterogeneous entity with a range of clinical phenotypes, here we describe a presentation at one of the oldest ages found to date in the available literature and its spontaneous resolution in the absence of treatment. Case presentation: A 75-year-old man presented with new-onset right-sided cervical lymphadenopathy and fever, weight loss, fatigue, and anorexia. Physical exam revealed cervical and axillary lymphadenopathy. CT chest/abdomen/pelvis showed extensive adenopathy in the axillary regions, groin, mediastinum, retroperitoneum, splenic hilum, gastrohepatic ligament and porta hepatis, and celiac chains. Left axillary lymph node excisional biopsy revealed sinus histiocytosis with massive lymphadenopathy, consistent with a diagnosis of RDD. Flow cytometry showed mixed polytypic B-cell and T-cell subsets with polyclonal plasma cells. Immunofixation was negative for monoclonal immunoglobulins. On seeing a hematologist one month later, the patient’s symptoms had resolved and he had gained 10+ pounds. Discussion: Rosai-Dorfman Disease is a rare non–Langerhans cell histiocytosis most often seen in children and young adults, although it has been reported up to age 79 years. It typically presents with markedly enlarged, non-tender cervical lymphadenopathy; however, other nodal and extranodal sites can be involved. Due to the rarity of the disease there is a lack of robust data regarding specific treatment modalities, although consensus guidelines were published in 2018 recommending various treatment options, including corticosteroids, chemotherapy, radiation, and surgery. Spontaneous resolution may be observed but can take many months to years. Keywords: sRosai-Dorfman disease; Sinus histiocytosis with massive lymphadenopathy; Non–langerhans cell histiocytosis.

Prospects of mesenteric lymphadenopathy in children with chronic abdominal pain (CAP).

Objective: To evaluate the incidence rate and severity of mesenteric lymphadenopathy in children presenting with CAP in comparison with healthy counterparts. Study Design: Prospective Cross-sectional study. Setting: Department of Pediatric, Nishtar Medical University &amp; Hospital Multan. Period: June 2020 to June 2021. Material &amp; Methods: The prospective cross-sectional study included children aged between 5 to 15 years who were divided into two groups: the study group included children who presented with CAP and the control group included the ones who visited the hospital to undergo abdominal sonography for other reasons. All the study population underwent analysis through abdominal ultrasonography. The existence of enlarged nodules, their size, location, and other related findings was assessed. Baseline characteristics were analyzed in both groups through descriptive statistics whereas Pearson's Chi-square test was performed for comparison of categorical variables. Results: After passing through the study criteria, a total of 80 cases were compared with 110 controls. No significant difference was between the two genders in terms of the occurrence of mesenteric lymphadenopathy. 62 (77.5%) cases were found positive for mesenteric lymph nodes (MLN) by ultrasonography as compared to 19 (17.2%) positive controls. Among them, 42 CAP (52.5%) cases had significant MLN (&gt;10mm long axis or ≥5 mm short axis) while 8 (7.2%) controls were found to have significant MLN (p&lt;0.001). The mesenteric lymph nodes were most commonly located in the right iliac fossa (82%) and peri-umbilical region (75.1%). Conclusion: Mesenteric lymphadenopathy is a significant finding in children with chronic abdominal pain.

Clinico-pathological study of cervical lymph nodes in children using ultrasound scan and FNAC: a hospital-based study

Background: Cervical lymphadenopathy is one of the commonest clinical diagnostic dilemmas in children. The diagnosis plays key role in the management of cervical lymphadenopathy. Various methods of diagnosis include non-invasive and invasive procedures. Ultrasonography is a non-invasive readily available investigation for evaluation of cervical lymph nodes. One of the most reliable, less expensive diagnostic procedure is fine needle aspiration cytology (FNAC).Methods: A prospective study was conducted on 150 children in SVS Medical College Hospital, Mahabubnagar between January 2017 and January 2020. Ultrasonography followed by FNAC of lymph node was done in all children. Microsoft office excel software used for the data analysis. Sample size was calculated with 85% confidence level and 5% margin of error.Results: Out of 150 patients 79 were non-specific reactive lymphadenitis. 54 were granulomatous lymphadenitis.15 were lymphomas. 2 were malignant.Conclusions: Both ultrasonography and FNAC are very useful tools in the evaluation of cervical lymphadenopathy in children.

Mast Cell Counts and Microvessel Density Expressions in Hodgkin’s Lymphoma and Reactive Lymphadenopathy in Children

Mast Cell Counts and Microvessel Density Expressions in Hodgkin’s Lymphoma and Reactive Lymphadenopathy in Children