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Wills C, Mercer K, Malysz J, Rivera Galvis L, Gowda C. Chronic Generalized Lymphadenopathy in a Child—Progressive Transformation of Germinal Centers (PTGC). CHILDREN 2022; 9:children9020214. [PMID: 35204936 PMCID: PMC8869933 DOI: 10.3390/children9020214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/29/2022] [Accepted: 01/30/2022] [Indexed: 11/16/2022]
Abstract
Background: Enlarged lymph nodes are a common complaint in a Pediatrician’s office. Diagnosis of reactive lymphadenopathy secondary to infectious, inflammatory, immune dysregulation calls for clinical investigation, including a thorough history, physical exam, imaging, and less often, a biopsy of the lymph node. Here we discuss a rare presentation of extensive generalized, chronic, waxing, and waning lymphadenopathy diagnosed as Progressive Transformation of Germinal Centers (PTGC) and the course of illness over eight years follow up period. Discussion: Progressive Transformation of Germinal Centers (PTGC) is considered a benign condition, but extensive recurrent generalized lymphadenopathy in a very young child has not been reported before. This case demonstrates the importance of long-term follow-up and tailoring the diagnostic work-up and management based on new signs and symptoms. Here we focus on the clinical considerations and management of complex presentation of a common clinical finding.
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Affiliation(s)
- Carson Wills
- Department of Graduate Education, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA;
| | - Katherine Mercer
- Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA;
| | - Jozef Malysz
- Department of Pathology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA; (J.M.); (L.R.G.)
| | - Lidys Rivera Galvis
- Department of Pathology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA; (J.M.); (L.R.G.)
| | - Chandrika Gowda
- Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA;
- Correspondence: ; Tel.: +1-717-531-6012
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Darré T, Doukouré B, Djiwa T, Amana B, Bissa H, Napo-Koura G. Cervical lymphadenopathy of Togolese children in a tropical context: clinicopathological study. Trop Doct 2020; 51:96-99. [PMID: 32814507 DOI: 10.1177/0049475520947882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our study describes the epidemiology and aetiology of cervical lymphadenopathy in children diagnosed between 2003 and 2017 at the pathology laboratory of Lomé, Togo. A total of 221 cases were collected. The average age of diagnosis of the study population was 9.8 ± 0.3 years and consisted of 118 (53.4%) boys. HIV was confirmed by indirect ELISA test in 69 (31.2%) cases. The cohort consisted of infections (n = 128, 57.9%), tumours (n = 85, 38.5%) and others (n = 8, 1.6%). The main infectious aetiology was tuberculosis (n = 84). Tumour aetiology consisted of 79 primary malignancies and three metastatic cases. Primary tumours consisted predominantly of lymphoma (n = 74), with Burkitt's lymphoma (n = 44) being the most common. Tuberculosis on a background of HIV infection remains the dominant cause of cervical lymphadenopathy in the tropical region of Togo.
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Affiliation(s)
- Tchin Darré
- MD, Professor, Department of Pathology, University Teaching Hospital of Lomé, Togo
| | - Brahima Doukouré
- MD, Professor, Department of Pathology, University Teaching Hospital of Cocody, Abidjan, Ivory Coast
| | - Toukilnan Djiwa
- MD, Assistant-Professor, Department of Pathology, University Teaching Hospital of Lomé, Togo
| | - Bathokédeou Amana
- MD, Professor, Department of Head and Neck Surgical, University Teaching Hospital of Lomé, Togo
| | - Haréfétéguéna Bissa
- MD, Assistant-Professor, Department of Stomatology, University Teaching Hospital of Lomé, Togo
| | - Gado Napo-Koura
- MD, PHD, Professor, Department of Pathology, University Teaching Hospital of Lomé, Togo
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Grazioli P, Bazzana T, Berlucchi M, Nassif N, Tonni D, Redaelli de Zinis LO. Minimally invasive approach to suppurated cervical lymphadenitis in children: Our experience on 60 patients. Clin Otolaryngol 2018; 43:1177-1179. [PMID: 29687954 DOI: 10.1111/coa.13117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2018] [Indexed: 11/30/2022]
Affiliation(s)
- P Grazioli
- Pediatric Otolaryngology Head Neck Surgery, Children Hospital "ASST Spedali Civili", Brescia, Italy
| | - T Bazzana
- Pediatric Otolaryngology Head Neck Surgery, Children Hospital "ASST Spedali Civili", Brescia, Italy
| | - M Berlucchi
- Pediatric Otolaryngology Head Neck Surgery, Children Hospital "ASST Spedali Civili", Brescia, Italy
| | - N Nassif
- Pediatric Otolaryngology Head Neck Surgery, Children Hospital "ASST Spedali Civili", Brescia, Italy
| | - D Tonni
- Pediatric Otolaryngology Head Neck Surgery, Children Hospital "ASST Spedali Civili", Brescia, Italy
| | - L O Redaelli de Zinis
- Pediatric Otolaryngology Head Neck Surgery, Children Hospital "ASST Spedali Civili", Brescia, Italy.,Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Section of Head and Neck Surgery, University of Brescia, Brescia, Italy
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Gómez Cadavid E, Giraldo LM, Espinal DA, Hurtado IC. [Clinical and histological characteristics of adenopathies in paediatric patients]. ACTA ACUST UNITED AC 2016; 87:255-60. [PMID: 26778009 DOI: 10.1016/j.rchipe.2015.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 11/10/2015] [Accepted: 11/23/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lymphadenopathy is a common cause for medical consultation in the child population, accounting for up to 44% in children under 5 years old. In some cases, it is required to take lymph node biopsy specimens in order to clarify the diagnosis. OBJECTIVE To describe the clinical and histological features of paediatric patients with lymphadenopathy and lymph node biopsies. PATIENTS AND METHOD Descriptive and retrospective study conducted in Medellin (Colombia) in a fourth-level hospital between January 1st of 2009 and December 31st of 2012. In the study, lymph node biopsy specimens were taken from children under 15 years old. Demographic, clinical and laboratory features, and characteristics of the patients were evaluated, as well as the histopathological diagnosis of the lymph node biopsies. RESULTS From the child population, 61 children met the eligibility criteria and 33 (54.1%) of them were male with an average age of 6 years old. The most common pathological diagnoses in the study group were as follows: reactive hyperplasia (50.8%), neoplasms (27.9%), chronic granulomatous disease (4.9%), and bacterial infection (3.3%). It could be concluded from the findings in the study that Hodgkin lymphoma is very common among the neoplastic diseases, with 18%, and the most frequent location was the neck with 60.6%. CONCLUSIONS This study demonstrates the importance of performing a differential diagnosis when approaching patients with lymphadenopathy. As reported in the world medical literature, benign origin is the most common cause of lymphadenopathy in children.
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Affiliation(s)
- Eliana Gómez Cadavid
- Departamento de Pediatría, Hospital Pablo Tobón Uribe, Medellín, Colombia; Departamento de Pediatría, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Lina María Giraldo
- Departamento de Pediatría, Universidad Pontificia Bolivariana, Medellín, Colombia
| | | | - Isabel Cristina Hurtado
- Departamento de Pediatría, Universidad Pontificia Bolivariana, Medellín, Colombia; Departamento de Pediatría, Universidad del Valle, Cali, Colombia.
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Chiappini E, Camaioni A, Benazzo M, Biondi A, Bottero S, De Masi S, Di Mauro G, Doria M, Esposito S, Felisati G, Felisati D, Festini F, Gaini RM, Galli L, Gambini C, Gianelli U, Landi M, Lucioni M, Mansi N, Mazzantini R, Marchisio P, Marseglia GL, Miniello VL, Nicola M, Novelli A, Paulli M, Picca M, Pillon M, Pisani P, Pipolo C, Principi N, Sardi I, Succo G, Tomà P, Tortoli E, Tucci F, Varricchio A, de Martino M, Italian Guideline Panel For Management Of Cervical Lymphadenopathy In Children. Development of an algorithm for the management of cervical lymphadenopathy in children: consensus of the Italian Society of Preventive and Social Pediatrics, jointly with the Italian Society of Pediatric Infectious Diseases and the Italian Society of Pediatric Otorhinolaryngology. Expert Rev Anti Infect Ther 2015; 13:1557-67. [PMID: 26558951 DOI: 10.1586/14787210.2015.1096777] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
UNLABELLED Cervical lymphadenopathy is a common disorder in children due to a wide spectrum of disorders. On the basis of a complete history and physical examination, paediatricians have to select, among the vast majority of children with a benign self-limiting condition, those at risk for other, more complex, diseases requiring laboratory tests, imaging and, finally, tissue sampling. At the same time, they should avoid expensive and invasive examinations when unnecessary. The Italian Society of Preventive and Social Pediatrics, jointly with the Italian Society of Pediatric Infectious Diseases, the Italian Society of Pediatric Otorhinolaryngology, and other Scientific Societies, issued a National Consensus document, based on the most recent literature findings, including an algorithm for the management of cervical lymphadenopathy in children. METHODS The Consensus Conference method was used, following the Italian National Plan Guidelines. Relevant publications in English were identified through a systematic review of MEDLINE and the Cochrane Database of Systematic Reviews from their inception through March 21, 2014. RESULTS Basing on literature results, an algorithm was developed, including several possible clinical scenarios. Situations requiring a watchful waiting strategy, those requiring an empiric antibiotic therapy, and those necessitating a prompt diagnostic workup, considering the risk for a severe underling disease, have been identified. CONCLUSION The present algorithm is a practice tool for the management of pediatric cervical lymphadenopathy in the hospital and the ambulatory settings. A multidisciplinary approach is paramount. Further studies are required for its validation in the clinical field.
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Affiliation(s)
- Elena Chiappini
- a Paediatric Infectious Disease Unit, Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy
| | - Angelo Camaioni
- b ENT Department , San Giovanni-Addolorata Hospital , Rome , Italy
| | - Marco Benazzo
- c Department of Otorhinolaryngology, "San Matteo" Hospital , University of Pavia , Pavia , Italy
| | - Andrea Biondi
- d Paediatric Haematology-Oncology Department and "Tettamanti" Research Centre , Milano-Bicocca University, "Fondazione Mbbm", San Gerardo Hospital , Monza , Italy
| | - Sergio Bottero
- e ENT Unit, Department of Surgery and Transplantation Centre , Bambino Gesù Children's Hospital, IRCCS , Rome , Italy
| | | | | | | | - Susanna Esposito
- i Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico , Università Degli Studi Di Milano, Milan , Milan , Italy
| | - Giovanni Felisati
- j Department of Otolaryngology , San Paolo Hospital, University of Milan , Milan , Italy
| | - Dino Felisati
- j Department of Otolaryngology , San Paolo Hospital, University of Milan , Milan , Italy
| | - Filippo Festini
- k Department of Health Science , University of Florence , Florence , Italy
| | - Renato Maria Gaini
- l Department of Otorhinolaryngology , San Gerardo Hospital , Monza , Italy.,m Department of Surgery and Translational Medicine , University of Milano-Bicocca , Milan , Italy
| | - Luisa Galli
- a Paediatric Infectious Disease Unit, Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy
| | - Claudio Gambini
- n Pathology Unit , Istituto Giannina Gaslini , Genua , Italy
| | - Umberto Gianelli
- o Fondazione Ircss Ca' Granda-Ospedale Maggiore Policlinico , Italy University of Milan , Milan , Italy
| | | | - Marco Lucioni
- q Otolaryngology Unit , Vittorio Veneto Hospital , Vittorio Veneto , Italy
| | - Nicola Mansi
- r ENT Unit , Santo Bono Posillipo Hospital , Naples , Italy
| | - Rachele Mazzantini
- a Paediatric Infectious Disease Unit, Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy
| | - Paola Marchisio
- i Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico , Università Degli Studi Di Milano, Milan , Milan , Italy
| | - Gian Luigi Marseglia
- s Department of Pediatrics , University of Pavia, Fondazione Irccs Policlinico San Matteo , Pavia , Italy
| | | | - Marta Nicola
- u Department of Molecular Medicine , University of Pavia , Pavia , Italy
| | - Andrea Novelli
- v Department of Health Sciences, Section of Pharmacology , University of Florence , Florence , Italy
| | - Marco Paulli
- w Department of Pathology, Fondazione Irccs Policlinico San Matteo, and Department of Molecular Medicine , University of Pavia , Pavia , Italy
| | | | - Marta Pillon
- y Oncoemaology Unit, Department of Paediatrics , University of Padua , Padua , Italy
| | - Paolo Pisani
- z Otorhinolaryngology Unit, Head and Neck Department , San Paolo Hospital, University of Milan , Milan , Italy
| | - Carlotta Pipolo
- aa Department of Cardiovascular Surgery , Ncc Città Di Alessandria Hospital , Alessandria , Italy
| | - Nicola Principi
- i Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico , Università Degli Studi Di Milano, Milan , Milan , Italy
| | - Iacopo Sardi
- ab Neuro-Oncology Unit, Meyer Meyer Univeristy Hospital , Florence , Italy
| | - Giovanni Succo
- ac Otorhinolaryngology Service, Department of Oncology , San Luigi Gonzaga Hospital, University of Turin , Turin , Italy
| | - Paolo Tomà
- ad Department of Diagnostic Imaging , Children's Hospital Bambino Gesù , Rome , Italy
| | | | - Filippo Tucci
- af University Hospital Pediatric Department , Bambino Gesù Children's Hospital, Rome , Rome , Italy
| | | | - Maurizio de Martino
- a Paediatric Infectious Disease Unit, Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy
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