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Stanford EF, Levine HM, Cabana MD, Anosike BI. Lymphadenopathy: Differential Diagnosis and Indications for Evaluation. Pediatr Rev 2024; 45:429-439. [PMID: 39085185 DOI: 10.1542/pir.2023-006291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 08/02/2024]
Abstract
Lymphadenopathy is a common finding on physical examination in the pediatric population. Although it is often physiologic, lymphadenopathy can also be associated with more serious illnesses and has many possible etiologies. A broad differential diagnosis can be narrowed with a thorough clinical history, physical examination, laboratory studies, and imaging. The goal of this review is to provide a framework for understanding normal physiology, identify when enlarged lymph nodes may be associated with pathology, develop differential diagnoses associated with lymphadenopathy, and apply a systematic approach for diagnostics and appropriate management, with a focus on findings concerning for malignancy and the initial evaluation.
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Thompson JA, Bertoni D, Decuzzi J, Isaiah A, Pereira KD. Ultrasound versus fine needle aspiration for the initial evaluation of pediatric cervical lymphadenopathy-A systematic review. Int J Pediatr Otorhinolaryngol 2023; 166:111485. [PMID: 36812785 DOI: 10.1016/j.ijporl.2023.111485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVE Cervical lymphadenopathy is a frequent finding in children that poses diagnostic challenges. We sought to compare the utility of fine needle aspiration (FNA) with ultrasound (US) for evaluating pediatric cervical lymphadenopathy based on published literature. STUDY DESIGN In October 2019, we performed a comprehensive electronic search of PubMed, OVID (MEDLINE), EMBASE, and Scopus databases. Two authors independently screened and assessed full-text reports of potentially eligible studies. We compared sensitivity, specificity, positive predictive value estimates, and balanced accuracy for determining the underlying etiology of lymphadenopathy. RESULTS The initial search returned 7736 possible studies, of which 31 met the criteria for inclusion. A total of 25 studies were included in the final analysis, with a total of 4721 patients, of which 52.8% were male. Of these, 9 (36.0%) examined US, and 16 (64%) examined fine needle aspiration. The pooled balanced accuracy for determining etiology was 87.7% for US and 92.9% for FNA. Reactive lymphadenopathy was identified in 47.9%, 9.2% were malignant, 12.6% were granulomatous, and 6.6% were non-diagnostic. CONCLUSIONS In this systematic review, US was identified as an accurate initial diagnostic imaging modality in children. Fine needle aspiration was found to play a significant role in ruling out malignant lesions and potentially avoiding excisional biopsy.
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Affiliation(s)
- Joshua A Thompson
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Dylan Bertoni
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Julianna Decuzzi
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Amal Isaiah
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kevin D Pereira
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA.
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Wang H, Hariharan VS, Sarma S. Diagnostic accuracy of fine-needle aspiration cytology for lymphoma: A systematic review and meta-analysis. Diagn Cytopathol 2021; 49:975-986. [PMID: 34004059 DOI: 10.1002/dc.24800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/12/2021] [Accepted: 05/08/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Fine-needle aspiration cytology (FNAC) has become one of the most useful modalities for diagnosis and staging of lymphoma. However, diagnostic accuracy of this technique has been reported with varying results across several studies around the world. Hence, this meta-analysis was done to assess the accuracy of FNAC for lymphoma diagnosis. METHODS We conducted a systematic search for all studies reporting the diagnostic accuracy of FNAC for lymphoma in the databases of PubMed Central, MEDLINE, EMBASE, MEDLINE, SCOPUS and Cochrane library from inception till January 2021. Meta-analysis was performed using STATA software "midas" package. RESULTS Forty-seven studies with 7268 patients were included. The pooled sensitivity and specificity of FNAC for diagnosing lymphoma were 93% (95% CI, 90%-95%) and 97% (95% CI, 95%-98%), respectively. Likelihood ratio positive was 33.5 (95% CI, 18.5-60.7) and likelihood ratio negative was 0.07 (0.05-0.11) making the technique to occupy the left upper quadrant in LR scattergram indicating that FNAC can be used for confirmation and exclusion. There was significant heterogeneity with significant chi-square test and I2 statistic >75%. There was significant publication bias as per Deek's test and funnel plot. CONCLUSION To summarize, our study found that FNAC has a vital role as a diagnostic tool for lymphoma with higher sensitivity and specificity. Further studies assessing the accuracy of FNAC on specific types of lymphoma is required.
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Affiliation(s)
- Huan Wang
- Department of Hematology Oncology, Taizhou People's Hospital, Taizhou, Jiangsu Province, 225300, China
| | | | - Susmita Sarma
- Department of Pathology, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, India
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Weskott HP. Sonografische Lymphknotendiagnostik im Bereich der unteren Extremitäten. PHLEBOLOGIE 2020. [DOI: 10.1055/a-1247-5486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ZusammenfassungDie Sonografie dient der Detektion und Charakterisierung tastbarer Resistenzen oder zufällig entdeckter Lymphknoten (LK) der unteren Extremitäten. Meist handelt es sich um chronisch entzündliche oder reaktive Lymphknoten ohne klinische Relevanz. Sie finden sich fast immer nur inguinal, während LK in der Kniekehle sehr selten auftreten. Für die Differenzialdiagnose kommt neben Anamnese und Klinik der B-Bild-Sonografie sowie der Gefäßarchitektur eine wegweisende Rolle zu. Wegen der unspezifischen sonografischen Befunde kann bei einem singulären LK nicht sicher zwischen entzündlichen und Lymphomerkrankungen unterschieden werden: So findet sich eine Rindenverdickung bei erhaltener Gefäßarchitektur sowohl bei Lymphomen als auch bei entzündlich-reaktiven LK. Eine US-gezielte Biopsie kann diagnostisch wegweisend sein. Eine metastatische Transformation geht sonografisch oft mit einer Zerstörung der LK-Architektur und des geordneten Gefäßbildes einher. Wichtig sind ferner die LK-Abgrenzbarkeit und die zentrale Ischämie in der farbkodierten und kontrastverstärkten Sonografie.
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Ronchi A, Caputo A, Pagliuca F, Montella M, Marino FZ, Zeppa P, Franco R, Cozzolino I. Lymph node fine needle aspiration cytology (FNAC) in paediatric patients: Why not? Diagnostic accuracy of FNAC in a series of heterogeneous paediatric lymphadenopathies. Pathol Res Pract 2020; 217:153294. [PMID: 33290901 DOI: 10.1016/j.prp.2020.153294] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 12/22/2022]
Abstract
Fine needle aspiration cytology (FNAC) can be a precious tool for the evaluation of lymphadenopathies in children and adolescents. The purpose of this study was to analyse the diagnostic accuracy of FNAC in a paediatric lymph node series. We report a series of 76 patients, aged up to 19 years, who underwent lymph node FNAC. In our series, 57 cases were diagnosed as non-neoplastic, including benign reactive hyperplasia and other inflammatory lesions, 18 cases were diagnosed as malignant and 1 case was diagnosed as suspicious for lymphoproliferative process, not otherwise specified. Sensitivity, specificity, positive predictive value and negative predictive value were 93 %, 100 %, 100 % and 98 %, respectively. Diagnostic accuracy resulted 98.6 %. FNAC is an accurate, minimally invasive method with minimal complications that allows evaluation of paediatric lymphadenopathies and a correct triage of reactive/inflammatory and neoplastic lymphadenopathies. The application of rapid on-site evaluation, the realization of a cell block and the application of ancillary diagnostic tests, including at least immunocytochemistry and flow cytometry, allows to achieve an excellent diagnostic performance.
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Affiliation(s)
- Andrea Ronchi
- Division of Pathology, Department of Mental and Physical Health and Preventive Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandro Caputo
- Department of Pathology of the Azienda Ospedaliera Universitaria "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Francesca Pagliuca
- Division of Pathology, Department of Mental and Physical Health and Preventive Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco Montella
- Division of Pathology, Department of Mental and Physical Health and Preventive Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Federica Zito Marino
- Division of Pathology, Department of Mental and Physical Health and Preventive Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Pio Zeppa
- Department of Pathology of the Azienda Ospedaliera Universitaria "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Renato Franco
- Division of Pathology, Department of Mental and Physical Health and Preventive Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy.
| | - Immacolata Cozzolino
- Division of Pathology, Department of Mental and Physical Health and Preventive Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
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Otolaryngologist and pediatric oncologist perspectives on the role of fine needle aspiration in diagnosing pediatric head and neck masses. Int J Pediatr Otorhinolaryngol 2019; 121:34-40. [PMID: 30861425 DOI: 10.1016/j.ijporl.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/29/2019] [Accepted: 03/04/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine how otolaryngologists and pediatric oncologists differ in their initial approach to diagnosing head and neck masses in children and adolescents. METHODS We designed an electronic 28-question survey consisting of 4 clinical cases and one referral case varying by patient age, history, and physical exam findings. The survey was sent anonymously to pediatric oncologists and otolaryngologists at institutions in the United States and Canada. RESULTS Two hundred and thirty one pediatric oncologists (29.4%) and 87 otolaryngologists (39.5%) completed the survey. Otolaryngologists were significantly more likely to recommend performing an FNA than oncologists in all four cases; less than 7% of pediatric oncologists recommended FNA for head and neck mass evaluation. Of providers who recommended FNA, otolaryngologists were more likely to do so because of diagnostic yield when compared to pediatric oncologists. However, when referred a patient with an FNA demonstrating non-Hodgkin lymphoma, the majority of pediatric oncologists (73.6%) and otolaryngologists (78.7%) would complete the staging work-up and begin treatment. If the same patient was referred with an FNA that demonstrated non-specific inflammation, most oncologists (91.0%) and otolaryngologists (94.4%) would biopsy the mass. CONCLUSION Otolaryngologists and pediatric oncologists differ in their initial approach to diagnosing head and neck masses in children, yet they both would recommend treating a patient with a positive FNA. This highlights important differences in the diagnostic process depending on which provider sees the patient first. Further studies assessing the sensitivity and specificity are needed to determine the true diagnostic yield of FNAs in the assessment of head and neck masses in children and adolescents, especially with increasing need for molecular and genomic profiling.
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Abstract
Cervical lymphadenopathy affects as many as 90% of children aged 4 to 8 years. With so many children presenting to doctors' offices and emergency departments, a systematic approach to diagnosis and evaluation must be considered. In the following review, we aim to provide the pediatric clinician with a general framework for an appropriate history and physical examination, while giving guidance on initial diagnostic laboratory testing, imaging, and potential need for biopsy. The most common cause of cervical lymphadenopathy in the pediatric population is reactivity to known and unknown viral agents. The second most common cause includes bacterial infections ranging from aerobic to anaerobic to mycobacterial infections. Malignancies are the most concerning cause of cervical lymphadenopathy.The explosion in the use of ultrasonography as a nonradiating imaging modality in the pediatric population has changed the diagnostic algorithm for many clinicians. We aim to provide some clarity on the utility and shortcomings of the imaging modalities available, including ultrasonography, computed tomography, and magnetic resonance imaging.
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Affiliation(s)
- Michael S Weinstock
- Cohen Children's Medical Center, Hofstra Northwell School of Medicine, New Hyde Park, NY.,Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Neha A Patel
- Cohen Children's Medical Center, Hofstra Northwell School of Medicine, New Hyde Park, NY
| | - Lee P Smith
- Cohen Children's Medical Center, Hofstra Northwell School of Medicine, New Hyde Park, NY
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Clinical approach to pediatric neck masses: Retrospective analysis of 98 cases. North Clin Istanb 2017; 4:225-232. [PMID: 29270570 PMCID: PMC5724916 DOI: 10.14744/nci.2017.15013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 07/23/2017] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE: Pediatric neck masses (PNMs) are a frequently encountered problem in otorhinolaryngology practice. The clinical approach to cervical masses in childhood varies from that of adults. Due to differences among clinicians in the assessment of a PNM, studies investigating this subject are significant contributions to the literature. For this reason, a review was conducted of pediatric PNM cases with an open biopsy (incisional/excisional) and a histopathological diagnosis. METHODS: The hospital records of 98 (34 girls, 64 boys) pediatric patients aged between 8.5 months and 16 years were reviewed. The history, physical examination findings, blood tests, medical treatments, imaging reports, and the pathology and/or microbiology results of the patients were recorded and evaluated. The cervical masses were categorized according to the etiology, imaging features, size, and location. RESULTS: Surgical biopsy was planned due to the suspicion of malignancy, typical clinical presentation or location, or size greater than 20 mm despite antibiotherapy for 2 to 6 weeks. Excisional biopsy (91.8%) was the first choice for histopathological sampling. Infectious masses were observed most commonly, followed by congenital and neoplastic masses, at a rate of 49%, 27.6%, and 23.4%, respectively. Hodgkin lymphoma was the most frequent type of malignancy (39.1%). Thyroglossal and branchial cysts constituted 74.1% of congenital masses. Sixty-seven percent of all masses were solid, and the lateral levels of the neck were the most affected locations (44.9%). CONCLUSION: In most cases, the diagnosis can be made with a detailed history and physical examination. In the presence of nonspecific findings, blood tests, imaging, and histopathological sampling are required. Ultrasound should be the first preference for imaging, and excisional biopsy is suggested rather than fine needle aspiration biopsy for histopathological sampling in pediatric neck masses.
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Silowash R, Pantanowitz L, Craig FE, Simons JP, Monaco SE. Utilization of Flow Cytometry in Pediatric Fine-Needle Aspiration Biopsy Specimens. Acta Cytol 2016; 60:344-353. [PMID: 27592067 DOI: 10.1159/000448510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 07/18/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND Fine-needle aspiration (FNA) coupled with flow cytometry (FC) can be helpful in suspicious pediatric lymph nodes or masses to exclude a lymphoproliferative disorder. The aim of this study was to analyze FC findings in a series of pediatric FNAs and to correlate abnormal findings with follow-up information. MATERIALS AND METHODS All pediatric FNAs performed at a tertiary-care children's hospital over a 46-month period that had FC performed were retrospectively analyzed and correlated with follow-up. RESULTS A total of 163 FNA procedures were performed in children (age ≤21 years), and 47 (28.8%) of these cases had FC performed. Specimens were mostly obtained from the head and neck (72.3% of cases). Nine cases (19.1%) had abnormal FC findings, including double-negative T cells (n = 3; 33.3%), double-positive T cells (n = 3; 33.3%), excess λ light chains (n = 1; 11.1%), weak CD34 positivity (n = 1; 11.1%), and T-lymphoblastic lymphoma (n = 1; 11.1%). CONCLUSION Unusual FC results that are not diagnostic of malignancy can be seen in lymph node FNA in a minority of young patients. In our series, these findings were seen mainly in small populations of T cells and occurred primarily in the setting of reactive lymphoid hyperplasia or ectopic thymic tissue. Cytopathologists performing FNA on children should be aware of these abnormalities and, although they may warrant further investigation and follow-up, they are unlikely to be associated with malignancy.
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Affiliation(s)
- Russell Silowash
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pa., USA
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Gwili NM, Hadi MA, Eldin AN, Hassab HM, Eldin YS, Fadel SH, Mashali NA. Lymphadenopathy in a series of Egyptian pediatric patients and the role of pathology in the diagnostic workup. Pediatr Dev Pathol 2014; 17:344-59. [PMID: 25419904 DOI: 10.2350/14-03-1480-oa.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Assessment of lymphadenopathy in children represents a diagnostic challenge because of the extensive differential diagnoses, including reactive and malignant conditions. Knowledge of the etiologic pattern of lymphadenopathy in a given geographical region is essential for making a confident diagnosis or for suspecting a disease. Hence, the present study was carried out to identify different etiologies of lymphadenopathy in children in our region and to assess parameters commonly associated with malignancy, with an emphasis on the role of pathology. One hundred and twenty patients aged 1 month to 18 years were included in the study. They were sorted into neoplastic and nonneoplastic (infectious and noninfectious) groups. In 56 patients, biopsy (fine needle aspiration cytology [FNAC], core needle, or excision biopsy) was essential to reach the final diagnosis. Sensitivity of FNAC in the differentiation between neoplastic and nonneoplastic lymphadenopathy was 92.3%, and specificity was 90.0%, with a diagnostic accuracy of 91.3%. We concluded that malignancy should be suspected in the following conditions: presence of abdominal or multiple symptoms; symptom duration of 1-6 months; generalized lymphadenopathy; multiple groups of lymph node (LN) involved; LN size > 2 cm; amalgamated, hard, fixed, and nontender LNs; certain abnormal complete blood count findings; blast cells in blood film; and elevated lactate dehydrogenase level. In such cases, LN biopsy is highly recommended. A final diagnosis was achieved after integrating information from history and clinical findings with the laboratory, radiological, pathological, and microbiological findings. Accordingly, an algorithm for primary diagnostic evaluation of children with lymphadenopathy is suggested.
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Affiliation(s)
- Noha M Gwili
- 1 Department of Pathology, Faculty of Medicine, Alexandria University, El-Azareeta, Egypt
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Abstract
This article provides an overview for evaluation and management of the pediatric patient with cervical lymphadenopathy. A thorough history and physical examination are crucial in developing a differential diagnosis for these patients. Although infectious causes of lymphadenopathy are more prevalent in the pediatric population compared with adults, neoplasms should also be considered. Judicious use of imaging studies, namely ultrasound, can provide valuable information for accurate diagnosis. Common and uncommon infectious causes of cervical lymphadenopathy are reviewed. Surgical intervention is occasionally necessary for diagnosis and treatment of infections, and rarely indicated for the possibility of malignancy. Indications for surgery are discussed.
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Affiliation(s)
- Tara L Rosenberg
- Department of Otolaryngology/Head and Neck Surgery, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, 1 Children's Way, Slot 836, Little Rock, AR 72202, USA
| | - Abby R Nolder
- Department of Otolaryngology/Head and Neck Surgery, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, 1 Children's Way, Slot 836, Little Rock, AR 72202, USA.
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Affiliation(s)
- David King
- Department of Paediatric Oncology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Jagadeesh Ramachandra
- Department of Paediatric Oncology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Daniel Yeomanson
- Department of Paediatric Oncology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
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Prathima S, Suresh T, Harendra Kumar M, Krishnappa J. Fine needle aspiration cytology in pediatric age group with special reference to pediatric tumors: a retrospective study evaluating its diagnostic role and efficacy. Ann Med Health Sci Res 2014; 4:44-7. [PMID: 24669329 PMCID: PMC3952295 DOI: 10.4103/2141-9248.126608] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Fine needle aspiration cytology (FNAC) is a well-established diagnostic technique in adult mass lesions but a comparatively new technique to pediatric lesions. Aim: The current study aims to evaluate the role of FNAC in pediatric age with special reference to pediatric tumors. Subjects and Methods: A retrospective study of FNAC in children ≤ 18 years of age presenting with mass lesions was studied for 5 years. Distribution of cases in different age groups, sex, and site of lesion was analyzed. Pediatric lesions were categorized into non-neoplastic, benign, and malignant conditions. Diagnostic efficacy was assessed by comparing subsequent histopathological examination wherever possible. Statistical Analysis: Epi info 07 (Centers for Disease Control and Prevention in Atlanta, Georgia (USA) 07) and values were presented as simple percentages. Results: FNAC was performed on 2903 cases in 5 years out of which 327 cases 11.3% (327/2903) were ≤ 18 years of age. Out of 327 cases, 180 cases 55% (180/327) were between 11 and 18 years. Male to female ratio was 1.15:1. The commonest site for FNAC was cervical lymph node swelling 48.3% (158/327). Reactive lymphadenitis was the commonest diagnosis among all mass lesions 38.8% (103/265), whereas Fibroadenoma 20.8% (10/49) was commonest diagnosis among benign lesions and among malignant lesions there were two cases 15.3% (2/13) each of Hodgkins and non-Hodgkins lymphoma and one case of chondrosarcoma. The positive predictive value of diagnosing malignant lesions on FNAC was 100%. Conclusions: The ease of FNAC along with its high diagnostic accuracy makes it a desirable method for diagnosing lesions in children.
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Affiliation(s)
- S Prathima
- Department of Pathology, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka, India
| | - Tn Suresh
- Department of Pathology, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka, India
| | - Ml Harendra Kumar
- Department of Pathology, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka, India
| | - J Krishnappa
- Department of Pediatrics, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka, India
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Abstract
PURPOSE OF REVIEW Cervical lymphadenopathy is common in the paediatric population and persistent lymphadenopathy of unknown cause is a frequent reason for otolaryngology referral. Diagnostic work-up is variable among physicians and deciding when excisional biopsy is necessary remains a challenge. This update reviews the recent literature on the work-up and diagnosis of paediatric cervical lymphadenopathy, with a focus on factors that may influence the need for excisional biopsy. RECENT FINDINGS The majority of paediatric cervical lymphadenopathy cases are benign, with infection and reactive lymphoid hyperplasia being far more common than malignancy. Ultrasound is the initial imaging modality of choice for paediatric cervical lymphadenopathy and can provide critical information to aid in diagnosis. Clinical factors that may predict malignancy include lymph node size greater than 2 cm, multiple levels of adenopathy and supraclavicular location. Biopsy should be strongly considered in patients with a combination of these factors or other suspicious findings such as severe systemic symptoms. SUMMARY Paediatric cervical lymphadenopathy is commonly encountered in general and paediatric otolaryngology practice; however, absolute guidelines for biopsy do not exist. Careful consideration of history, physical examination, laboratory work-up and diagnostic imaging must be used to guide the clinician in decision-making for biopsy.
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Abstract
Pediatric cervical lymphadenopathy is a challenging medical condition for the patient, family, and physician. There are a wide variety of causes for cervical lymphadenopathy and an understanding of these causes is paramount in determining the most appropriate workup and management. A thorough history and physical examination are important in narrowing the differential diagnosis. Diagnostic studies and imaging studies play an important role as well. This article reviews the common causes of lymphadenopathy, and presents a methodical approach to a patient with cervical lymphadenopathy.
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Ahmed HG, Elmubasher MB, Salih RAA, Elhussein GEMO, Ashankyty IMA. Fine Needle Aspiration Cytopathology of Pediatric Lympha denopathy among Sudanese Children. Asian Pac J Cancer Prev 2013; 14:4359-63. [DOI: 10.7314/apjcp.2013.14.7.4359] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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17
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Kelly MN, Tuli SS, Usher S, Tuli SY. A 6-year-old with acute-onset generalized lymphadenopathy. J Pediatr Health Care 2012; 26:465-70. [PMID: 22901313 DOI: 10.1016/j.pedhc.2012.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 06/28/2012] [Accepted: 07/01/2012] [Indexed: 10/28/2022]
Affiliation(s)
- Maria N Kelly
- Department of Pediatrics, University of Florida, Gainesville, FL, USA
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18
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Abstract
Ultrasound is most useful in detecting and characterizing peripheral and abdominal lymph nodes and infiltration of solid organs. B-mode criteria, such as size, shape, number, distribution architecture, echogenicity and delineation of margins are the basis for characterizing lymph nodes. Additionally color coding techniques such as color Doppler, B-flow and contrast-enhanced ultrasound (CEUS) contribute to the evaluation of the nodal vasculature and vessel architecture. Whenever possible high frequency probes should not only be used for evaluating peripheral lymph nodes but also for lymphatic infiltration of solid organs, especially the spleen. The CEUS technique will be of additional benefit in detecting characterizing potential lymphatic organ infiltration. Ultrasound is an ideal tool for guided punctures, for which core biopsies should be preferred over fine needle aspiration biopsy and CEUS can also be used for proving residual viable tissue after chemotherapy or radiation therapy.
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Affiliation(s)
- H-P Weskott
- Zentrale Sonographie-Abteilung, Klinikum Siloah, Klinikum Region Hannover, Roesebeckstr. 15, 30449, Hannover, Deutschland.
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US-guided percutaneous needle biopsy of anterior mediastinal masses in children. Pediatr Radiol 2012; 42:40-9. [PMID: 21863292 DOI: 10.1007/s00247-011-2204-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 06/16/2011] [Accepted: 06/21/2011] [Indexed: 01/08/2023]
Abstract
BACKGROUND Anterior mediastinal masses in children are clinically challenging, requiring prompt histological diagnosis. OBJECTIVE The purpose of this study was to review the experience with US-guided percutaneous core needle biopsy (PCNB) of anterior mediastinal masses in children, particularly with respect to safety and diagnostic accuracy. MATERIALS AND METHODS We retrospectively reviewed the clinical presentation, imaging, sedation approach, procedural details and pathology results of US-guided PCNB of mediastinal masses that occurred during an 8-year period (2001-2008). Complications were graded and pathology was categorized into four groups based on adequacy and diagnostic yield. RESULTS 32 US-guided PCNBs were performed on 32 children, mean age 12 years (range 18 months to 17 years), mean weight 48 kg (range 11.5 to 109 kg, median 49 kg). A coaxial US-guided technique was used, with a mean of 8.2 passes and a mean 7.6 cores obtained (range 2-15). There were no major complications. The biopsies were adequate in volume and quality of specimens in 29/32, and 25/32 were diagnostic. PCNB was diagnostic in all cases of non-Hodgkin disease. CONCLUSIONS Experience with anterior mediastinal masses suggests that US-guided PCNB can be considered a viable, safe and accurate method of reaching a diagnosis in the pediatric population.
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Tancredi A, Cuttitta A, de Martino DG, Scaramuzzi R. Ectopic hepatic tissue misdiagnosed as a tumor of lung. Updates Surg 2010; 62:121-3. [PMID: 20845011 DOI: 10.1007/s13304-010-0016-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 08/06/2010] [Indexed: 01/24/2023]
Abstract
The ectopic or accessory liver lobe is an uncommon congenital anatomic abnormality. It is considered to be the outcome of an abnormal development of liver tissue during embryologic period. In some cases, it may be secondary to a trauma or a surgical operation. Literature reports only anecdotal cases; there are not series. The most common localization is the abdominal cavity, but very rarely it can also be found in the thoracic cavity. In most cases, preoperative correct diagnosis is very difficult because it is unlikely to consider this rare condition in course of differential diagnosis. Most cases are misdiagnosed, and patients undergo surgical intervention with suspect of lung lesion. Some times the intrathoracic accessory lobe is an intraoperative incidental finding. In this report, we present the case of a young female patient who underwent surgical treatment for a suspect pulmonary lesion that at histological examination resulted to be an intrathoracic accessory hepatic lobe.
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Affiliation(s)
- Antonio Tancredi
- Unit of General Surgery 2nd and Thoracic Surgery, IRCCS "Casa Sollievo della Sofferenza" Hospital, Viale Cappuccini 1, 71013, San Giovanni Rotondo, FG, Italy,
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23
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Stanwell J, Drake D, Pierro A, Kiely E, Curry J. Pediatric Laparoscopic-Assisted Gastric Transposition: Early Experience and Outcomes. J Laparoendosc Adv Surg Tech A 2010; 20:177-81. [DOI: 10.1089/lap.2009.0062] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Joanna Stanwell
- Department of Pediatric Surgery, Great Ormond Street Hospital, London, United Kingdom
| | - David Drake
- Department of Pediatric Surgery, Great Ormond Street Hospital, London, United Kingdom
| | - Agostino Pierro
- Department of Pediatric Surgery, Great Ormond Street Hospital, London, United Kingdom
| | - Edward Kiely
- Department of Pediatric Surgery, Great Ormond Street Hospital, London, United Kingdom
| | - Joe Curry
- Department of Pediatric Surgery, Great Ormond Street Hospital, London, United Kingdom
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24
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Perger L, Lee EY, Shamberger RC. Management of children and adolescents with a critical airway due to compression by an anterior mediastinal mass. J Pediatr Surg 2008; 43:1990-7. [PMID: 18970930 DOI: 10.1016/j.jpedsurg.2008.02.083] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Revised: 02/24/2008] [Accepted: 02/29/2008] [Indexed: 10/21/2022]
Abstract
This study used retrospective review of patients with critical airway due to compression by an anterior mediastinal mass treated at a single pediatric teaching institution. Diagnostic workup is reviewed with a focus on diagnostic biopsy. Algorithm for streamlining the choice of biopsy technique and minimizing invasive procedures is suggested.
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Affiliation(s)
- Lena Perger
- Department of Surgery, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA
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25
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Affiliation(s)
- Nack-Gyun Chung
- Department of Pediatrics, St. Marys Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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26
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27
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Abstract
Head and neck masses represent a common clinical entity in children. In general, these masses are classified as developmental, inflammatory, or neoplastic. Having a working knowledge of lesions within this region and conducting a thorough history and physical examination generally enables the clinician to facilitate an appropriate workup and establish a diagnosis. The differential diagnosis is broad, and expeditiously distinguishing benign from malignant masses is critical for instituting a timely multidisciplinary approach to the management of malignant lesions. Neoplasms of the head and neck account for approximately 5% of all childhood malignancies. A diagnosis of malignancy may represent a primary tumor or metastatic foci to cervical nodes. In this review, we discuss the general approach to evaluating suspicious masses and adenopathy in the head and neck region and summarize the most common malignant neoplasms of the head and neck with regard to their incidence, clinical presentation, diagnostic evaluation, staging, and management. Thyroid, parathyroid, and salivary gland tumors are discussed elsewhere in this issue of Seminars in Pediatric Surgery.
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Affiliation(s)
- Paxton V Dickson
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
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28
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Chen F, Heller DS, Bethel C, Faye-Petersen O. Intrathoracic ectopic lobe of liver presenting as pulmonary sequestration. Fetal Pediatr Pathol 2005; 24:155-9. [PMID: 16338877 DOI: 10.1080/15227950500305520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Intrathoracic ectopic lobe of the liver in the presence of a normal intact diaphragm is extremely rare. We report a case of a 13-month-old male initially diagnosed with pneumonia and pulmonary sequestration who was found to have an intrathoracic liver lobe and intact diaphragm. The presence of this condition suggests an event preceding closure of the diaphragm and illustrates the unique potential of pediatric pathology to shed light on human embryology.
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Affiliation(s)
- Fan Chen
- Department of Pathology, UMDNJ-New Jersey Medical School, Newark, New Jersey 07101, USA
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29
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Affiliation(s)
- Linda S Nield
- Department of Pediatrics, West Virginia University, Morgantown, West Virginia, USA
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30
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Abstract
The assessment of lymphadenopathy in children is a common diagnostic problem in pediatrics. An understanding of the wide variety of diseases and conditions that may present as lymphadenopathy is essential to determining the most appropriate work up for an individual patient. Although the majority of these children will prove to have a benign disorder, it is important that the pediatrician also have an appreciation for the malignant diseases that may present with lymphadenopathy, so that in such cases the diagnosis of a serious or life-threatening disease can be made in a timely manner.
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Affiliation(s)
- Clare J Twist
- Division of Hematology, Oncology and Stem Cell Transplantation, Stanford University School of Medicine, CA 94305, USA.
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Abstract
The majority of anterior mediastinal tumors in children are malignant. The most common tumors in this location are lymphomas, germ cell tumors, and thymic masses. Most require an operation, either a biopsy or a resection, for cure. Because of their size and location, patients with these masses are at significant risk for cardiopulmonary complications when general anesthesia is administered. Of the many clinical, functional, and radiologic criteria used to identify the children at greatest risk for anesthetic complications, the peak expiratory flow rate (PEFR) and the tracheal cross-section area seem to be the most reliable. General anesthesia should not be administered to children if the PEFR and a tracheal cross section area are both less than 50% of predicted values. If both are greater than 50% of predicted values, general anesthesia can be administered safely. An algorithm is proposed for the preoperative evaluation and management of children with anterior mediastinal tumors.
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Affiliation(s)
- R R Ricketts
- Emory Children's Center, Emory University School of Medicine, Atlanta, GA 30322, USA
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