Associated symptoms of night sweats, weight loss, and hepatosplenomegaly also increase the chance of malignancy. Malignancy as a cause is also more common in children with chronic generalized lymphadenopathy, nodes greater than 3 cm in diameter, and nodes in the supraclavicular region. 5, 6 Malignant processes are more common in the age group of 2 to 12 years old and very rare in the age group of less than 2 years old. The higher rates are reported in series from oncology practices. Malignancy accounts for 11% to 24% of the diagnoses, depending on the nature of the group reporting their result. Mumps, thyroglossal duct, branchial cleft cyst, sternocleidomastoid tumor, cervical ribs, lymphatic malformation, hemangiomas, laryngocele, dermoid cyst Mediastinal: sarcoidosis, cystic fibrosis, histoplasmosis,Īxillary: local infection, brucellosis, immunization reactions, JRA Supraclavicular: histoplasmosis, coccidioidomycosis Preauricular: cat-scratch disease, chronic eye infections Occipital: tinea capitis, pediculosis capitis Lymphoma, leukemia, neuroblastoma, rhabdomyosarcoma, parotid tumor, nasopharyngeal tumor, solid tumor metastasis Staphylococcus aureus, group A Streptococcus (e.g., pharyngitis), anaerobes (periodontal disease), acute bacterial lymphadenitis, cat-scratch disease, tularemia, bubonic plague, diphtheria, chancroid, viral URI, mononucleosis, tuberculosis/atypical mycobacterium Miscellaneous: Addison disease, Castleman disease, Churg-Strauss syndrome, Kawasaki disease, Kikuchi disease, lipid storage disease, sarcoidosis Storage disorders: for instance, Gaucher disease, Niemann-Pick disease Lymphoma, leukemia, neuroblastoma, thyroid tumor, metastasis (e.g., osteosarcoma, glioblastoma)Īutoimmune disorders: for instance, JRA, SLE, drug reactions, CGD, lymphohistiocytosis, LCH, dermatomyositis Protozoal: for instance, toxoplasmosis, leishmaniasisįungal: for instance, coccidioidomycosis, Cryptococcus, histoplasmosis Viral: CMV, HIV, rubella, varicella, measles, EBV, herpes, hepatitisīacterial: typhoid, tuberculosis, mycobacterial, syphilis, LGV, leptospirosis, brucellosis Some comments are made about other regions. This chapter focuses primarily on lymphadenopathy in the cervical region. A key consideration is to resolve the family's fears of malignancy in an efficient and cost-effective manner. The primary goal of a consulting surgeon is to determine the need for a tissue diagnosis. Palpable epitrochlear and supraclavicular nodes should, however, be viewed with suspicion and trigger investigations. Many lymph nodes are palpable in children, and generally, cervical nodes less than 2 cm, axillary nodes less than 1 cm, and inguinal nodes less than 1.5 cm are considered physiologic in young children. This lymphoid tissue then normally diminishes throughout puberty. 1, 2 In addition, children have palpable nodes in most of the superficial lymphatic basins, including cervical, axillary, and inguinal regions that are nonpathologic there is progressive increase in lymphoid mass from birth until early adolescence. Lymphadenopathy, especially cervical lymphadenopathy, is quite common in childhood, with a reported prevalence of 28% to 55% in otherwise normal infants and children. Pathologic lymphadenopathy is usually a symptom of infectious, noninfectious conditions, or, in rare cases, malignant disease. Lymphadenopathy is defined as an enlargement or a change in the character of a lymph node.
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