Pediatric patient with lymphadenopathy: Benign or malignant?

Abstract

Objective: Lymphadenopathy (LAP) is a condition that is common especially in childhood, its etiology is mostly benign, but malignancy must be excluded by careful evaluation and follow-up. In this study, it was aimed to examine the etiological, clinical and laboratory features of cases whose peripheral LAP etiology was investigated. Material and Methods: Patients referred to Erzurum City Hospital Pediatric Hematology/Oncology and Pediatric Infectious Diseases Polyclinics between October 2018 and June 2020 due to LAP were evaluated retrospectively. Results: One hundred and seventy patients were evaluated. Eleven of them were non-LAP lesions in the head and neck region, and 159 were patients whose LAP etiology was investigated. While 152 of the patients had benign etiology, seven were diagnosed as malignant/premalignant. Most patients with benign etiology (58.5%, 93 patients) had non-specific LAP, and no causative agent could be isolated. In benign lymph nodes where the causative agent was detected, the most common diagnosis was Ebstein Bar virus in 15 (9.4%), tularemia in 12 (7.5%) and tuberculosis in 8 (5%) cases. Thirty-three patients (20%) underwent biopsy. Five of these patients were diagnosed with Lymphoma and one with autoimmune lymphoproliferative syndrome. Two patients were diagnosed with acute lymphocytic leukemia by bone marrow aspiration without LAP biopsy. In the evaluation of LAP in patients, statistically sig-nificant differences were found in the malignant/premalignant group compared to the benign etiology group in terms of pathological features such as generalization, duration of more than two weeks, size >3 cm, accompanying hepatosplenomegaly, accompanying B symptoms, hard/ fixed or rubbery consistency on palpation. Conclusion: Lymphadenopathy is a common finding in children during physical examination. Although it is usually reactive, it may be associated with malignant diseases, causing concern for both parents and pediatricians. In a child with LAP, if there is generalized LAP, if there is a history of LAP lasting longer than two weeks, if the LAP size is >3 cm, if it is ac-companied by hepatosplenomegaly, if there are B symptoms, and if it is hard/fixed or rubbery on palpation, malignancy should be investigated in these patients.