Assessment of childhood peripheral lymphadenopathies

Peripheral lymphadenopathy is a common finding in childhood. Although it is usually a benign, self-limiting condition, it may be clue for a serious underlying disease or malignancy. The purpose of this study is to evaluate the definiton of lymphadenopathy, the differential diagnosis of regional and generalized lymphadenopathy, the systematic approach to the assessment of a patient with lymphadenopathy, epidemiological characteristics, etiological distribution, clinical and laboratory findings, conditions that require biopsy; briefly, the diagnosis, examination and follow-up processes. Patients and Methods The cases that presented to ADÜ Faculty of Medicine, Department of Pediatric Oncology with the complaint of peripheral lymphadenopathy between January 2008 and December 2011 were examined in the study. The epidemiological characteristics, clinical and laboratory findings of the cases were evaluated retrospectively from their files. Statistical analysis was made using the SPSS ? 17.0 program. Findings Epidemiological and clinical data of 151 cases in total were reviewed. As a result of the examinations, masses that were not lymphadenopathies were detected in 14 cases (9%) which were excluded from the study. Of the remaining 137 cases, 91 (66%) were male, 46 (34%) were female and the mean age was 6,6 years. 130 (%) of the patients were diagnosed with benign whereas 7 (%) of them were diagnosed with malignant lymphadenopathy. The cases that were diagnosed as having malignant disease were between 6 and 12 years old and the diameter of the lymphadenopathy was bigger than 3 cm. The mean age of the cases that were diagnosed as having benign disease was 6,49 ± 4,30 years and the diameter of the lymphadenopathy was between 1-3 cm in 78%. When evaluated in terms of generality of the lymphadenopathy, 116 (85%) of the cases had regional lymphadenopathy whereas 21 (15%) of the cases had generalized lymphadenopathy. The duration of the symptoms were chronic , in 47 (34%) of the cases and acute in 90 (66%) of the cases and although the possibility of having chronic lymphadenopaty was higher in malignant cases compared to the benign ones, there were no statistically significant differences. The consistency in 71% of the malignant cases were fixated and 86% were rigid and elastic whereas 97% of the benign cases were moving and 57% were soft and the possibility of the consistency as being fixed, rigid and elastic was higher in the cases that were diagnosed as malignant compared to the benign ones and it was statistically significant. Malignant lymphadenopathy was detected in the 4 cases that had mediastinal enlargement in their chest X-rays and it was statistically significant. Excisional biopsy was performed in 14 cases. Malignant causes were detected in 7 (50%) of these cases. The most common cause was reactive lymph node hyperplasia (50%) in the benign group and Hodgkin lymphoma (86%) and nasopharynx cancer (1 case, 14%) in the malignant group. Conclusion eripheral lymphadenopathy is the most common complaint and physical examination finding in childhood. It usually develops due to benign causes whereas rarely it may be the finding of an underlying malignant disease. Malignancy is more likely in lymphadenopathies that are ongoing more than 4 weeks, bigger than 3 cm, rigid and fixed and in the cases that have pathology in the chest X-ray. Excisional biopsy should be planned in the lymphadenopathies with these characteristics. Key words: Children, peripheral lymphadenopathy, benign, malign.