Evaluation of patients applying to the pediatric hematology-oncology autpati̇ent clinic due to lymphadenopathy

ABSTRACT Introduction and Purpose: Lymph glands are located along the lymphatic channels. Lymph glands are spread throughout the body and are mostly located in the head and neck region. Lymphadenopathy (LAP) is one of the most common reasons for families to consult a doctor in childhood and can be seen at any age. With a good anamnesis and a detailed physical examination, information about lymph node enlargement can be obtained. However, it is of great importance for pediatricians to know the approach to the patient who comes with lymph node enlargement in terms of revealing infrequent and pathological causes and avoiding unnecessary examinations. In the vast majority of cases, limited and benign processes such as infections and nonspecific reactive hyperplasia are observed. More rarely, metabolic, immunological, neoplastic and other causes may be responsible. The aim of this study; Between January 1, 2016 and December 31, 2021, patients who applied to Dicle University Medical Faculty Pediatric Hematology and Oncology outpatient clinic with lymphadenopathy; Demographic characteristics, clinical laboratory imaging findings and etiology are evaluated retrospectively. Materials and Methods : In this study, 504 patients aged 1-18 years who applied to the Dicle University Faculty of Medicine Pediatric Hematology and Oncology outpatient clinic between January 1, 2016 and December 31, 2021 with lymphadenopathy were evaluated retrospectively. Age, gender, month of admission, complaint of admission presence of fever, previous infection, night sweats, location and extent of lymphadenopathy, weight loss, accompanying physical examination findings, complete blood count (hemoglobin, thrombocyte, leukocyte, neutrophil, lymphocyte, mean platelet volume), peripheral smear, EBV, CMV, toxoplasma, brucella, abdominal ultrasonography, neck ultrasonography, mediastinal width in the posteroanterior chest X-ray (PAAG), biochemical parameters (AST, ALT, LDH, Uric Acid), C-reactive protein (CRP) ), if any, the results of bone marrow aspiration and lymph node biopsy were recorded. Patients whose file records were missing and whose clinical and laboratory tests could not be reached were excluded from the study. The data were evaluated retrospectively from the information in the hospital records. Results: The files of 504 patients who applied for lymphadenopathy were analyzed. Of 504 patients, 367 (72.8%) were male and 137 (27.2%) were female. The ages of the patients ranged from 10 months to 211 months. In the lymph node examination of our cases with lymphadenopathy, 80.75% of the cases had local LAP and 19.25% of them had diffuse LAP. When the localities were examined, more than half of them were in the submandibular region (62%) and the second most common was in the cervical (19.6%) region. The postauricular region (0.84%) was the least common. All of our cases (100%) presented with the complaint of swelling in the neck. Fatigue was the second most common reason for admission. Biopsy was performed in 78 (15.5%) of the cases. Benign causes were found in 66 (84.6%) cases and malignant in 12 (15.4%) cases. In the ultrasonographic imaging performed on the patients presenting with lymphadenopathy, LAP with fatty hilum was detected in 418 patients (55.66%). There was no hilum in 11 (84.6%) of the malignant cases and the cortex was found to be thin. When our cases were examined seasonally, 115 (22.8%) applied in January, and 80 (15.8%) applied in December with the second frequency. In our study, the cases applied to us mostly in winter and autumn. When examined from a serological point of view; 31 of the cases were EBV VCAIgM(+), 38 of them were Anti-CMVIgM (+), 27 of them were Anti-Toxo IgM (+), 3 of them were Anti-Rubella IgM(+), 3 of them were anti-HCV (+) ), 2 anti-HAV IgM (+), 1 'iHBsAg (+) and 1 'iHBsAg (+) were detected in brucella (+). All 23 patients with high NLR were benign. When the NLR levels of benign and malignant cases were compared in our study, no statistically significant relationship was found. Conclusion: Lymphadenopathy (LAP) is one of the most common reasons for families to consult a doctor in childhood and can be seen at any age. Detailed anamnesis, physical examination, and simple laboratory tests are sufficient to guide the diagnosis. In the vast majority of cases, limited and benign processes such as infections and nonspecific reactive hyperplasia are observed. More rarely, immunological, metabolic and neoplastic etiologies are seen. Even though malignancy was found at a low rate in our study and in the literature, the rate of application to pediatric hematology-oncology outpatient clinics due to lymphadenopathy is very high. Keywords: Lymphadenoğathy, infection, malignancy