Retrospective evaluation of clinical, laboratory, and imaging characteristics in children presenting with head and neck lymphadenopathy to pediatric clinics

Objective: Lymphadenopathy (LAP) of the head and neck region is a common finding in the pediatric population, most frequently associated with benign etiologies; however, it may also represent the initial manifestation of certain malignant disorders. The aim of this study is to retrospectively evaluate the medical history, physical examination findings, and laboratory results of pediatric patients presenting with head and neck LAP, with the objectives of preventing diagnostic delays, avoiding unnecessary investigations, and proposing a diagnostic algorithm. Materials and Methods: This study retrospectively analyzed children aged 0–18 years who presented with complaints of head and neck lymphadenopathy to the outpatient clinics of the Department of Pediatrics, Faculty of Medicine, Karadeniz Technical University, between January 1, 2019, and December 31, 2024. Results: A total of 350 pediatric patients were evaluated in this study. Of these, 67.7% were male and 32.3% were female. The etiology was determined to be benign in 93.7% of cases and malignant in 6.3%. The majority of patients presented during the acute phase, most commonly with a history of recent upper respiratory tract infection. Among the 24 patients with a history of cat contact, cat scratch disease was identified in 11 cases. Dental caries were detected in 10% of the patients. Regional lymphadenopathy was observed in 94% of the cohort, with the submandibular lymph nodes being the most frequently affected region. In malignant cases, lymph nodes were larger than 2,5 cm, firm and fixed on palpation, and typically showed generalized involvement. The presence of B symptoms and hepatosplenomegaly was more common among malignant patients. Laboratory analyses revealed significant differences between benign and malignant cases. Malignant cases more frequently exhibited anemia, elevated absolute neutrophil counts and neutrophil-to-lymphocyte ratios, abnormalities in platelet counts, and increased levels of lactate dehydrogenase (LDH), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and uric acid.Ultrasonographic evaluation of malignant lymph nodes demonstrated round morphology, loss of the echogenic hilum, and marked cortical thickening. Conclusion: Although head and neck lymphadenopathy in childhood is most commonly associated with benign causes, the possibility of malignancy should always be considered. Clinical evaluation should include a detailed history, physical examination, and laboratory assessment directed toward common etiologies such as acute bacterial lymphadenitis or abscess, cat scratch disease, brucellosis, and infectious mononucleosis. In patients presenting with findings suggestive of malignancy—such as B symptoms, firm and fixed lymph nodes, accompanying hepatosplenomegaly, or the presence of blast cells in peripheral smear—ultrasonographic evaluation is essential. When ultrasonographic findings support malignancy, biopsy should not be delayed. Conversely, patients with findings consistent with reactive lymphadenopathy should be managed with clinical follow-up alone, avoiding unnecessary imaging studies, which can reduce both healthcare burden and patient anxiety. Additionally, in systemic infections such as cat scratch disease or Epstein–Barr virus (EBV) infection, it should be recognized that lymph node regression may take up to three months; thus, invasive procedures such as biopsy should not be planned prematurely.