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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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Gazula S, Rani VL, Jonathan GT, Kumar NN. Extraskeletal Ewing's Sarcoma Masquerading as Infantile Benign Neck Mass. J Indian Assoc Pediatr Surg 2019; 24:209-211. [PMID: 31258273 PMCID: PMC6568164 DOI: 10.4103/jiaps.jiaps_98_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Despite being the second most common malignant bone tumor, Ewing's sarcoma remains uncommon in younger children and seldom seen in neonates and infants. Extraskeletal locations are even rarer, hardly ever suspected, and often misdiagnosed, causing delays in management. The histologic similarities of Ewing's sarcoma to more common pediatric small-blue-round-cell tumors such as lymphoma and neuroblastoma necessitate immunohistochemistry and molecular genetics for clinching the diagnosis. We report a soft-tissue Ewing's sarcoma in a 4-month-old female infant masquerading as a benign neck mass clinically, radiologically, cytologically, and intraoperatively. We also reviewed literature for any existing guidelines on when to biopsy neck masses in the pediatric population.
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Affiliation(s)
- Suhasini Gazula
- Department of Paediatric Surgery, Employees State Insurance Corporation (ESIC) Medical College and Superspeciality Hospital, Hyderabad, Telangana, India
| | - V Leela Rani
- Department of Pathology, Employees State Insurance Corporation (ESIC) Medical College and Superspeciality Hospital, Hyderabad, Telangana, India
| | - G T Jonathan
- Head and Neck Oncologym, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - N Narender Kumar
- Department of Paediatric Surgery, Employees State Insurance Corporation (ESIC) Medical College and Superspeciality Hospital, Hyderabad, Telangana, India
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Çolak M, Eravcı FC, Karakurt SE, Karakuş MF, İkincioğulları A, Özcan KM. The Predictive Value of Neutrophil-to-Lymphocyte Ratio for Hodgkin's Lymphoma Diagnosis in Patients with Asymptomatic Cervical Lymphadenopathy. Indian J Otolaryngol Head Neck Surg 2019; 71:986-991. [PMID: 31742107 DOI: 10.1007/s12070-019-01676-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/27/2019] [Indexed: 12/31/2022] Open
Abstract
In patients with asymptomatic cervical lymphadenopathy, the physician often has to choose between evaluation via follow-up or open biopsy. Follow-up evaluation may lead to a delayed diagnosis of lymphoma, while an open biopsy is associated with surgical risks and costs. This dilemma can be avoided using predictive parameters. In the present study, we aimed to investigate whether neutrophil-to-lymphocyte ratio (NLR), a parameter which can be assessed quickly with ease and at low cost, has predictive value for Hodgkin's lymphoma diagnosis in patients with asymptomatic cervical lymphadenopathy. A total of 46 patients with asymptomatic cervical lymphadenopathy who underwent open biopsy were included in the study. Based on the biopsy results, the patients were divided into two groups, Hodgkin lymphoma (26 patients) and reactive lymphadenopathy (20 patients). The mean NLR in the groups was calculated and compared based on the results of complete blood count performed before biopsy. We found that mean NLR (P = 0.022) and mean neutrophil count (P = 0.046) were higher and mean lymphocyte count was lower (P = 0.054) in patients with Hodgkin's lymphoma compared to those in patients with reactive lymphadenopathy. Our results indicate that a high NLR may have predictive value for Hodgkin's lymphoma diagnosis in patients with asymptomatic cervical lymphadenopathy.
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Affiliation(s)
- Mustafa Çolak
- Department of Otorhinolaryngology, Health Sciences University, Ankara Numune Training and Research Hospital, Talatpaşa Blv. No: 44, 06230 Ankara, Turkey
| | - Fakih Cihat Eravcı
- Department of Otorhinolaryngology, Health Sciences University, Ankara Numune Training and Research Hospital, Talatpaşa Blv. No: 44, 06230 Ankara, Turkey
| | - Süleyman Emre Karakurt
- Department of Otorhinolaryngology, Health Sciences University, Ankara Numune Training and Research Hospital, Talatpaşa Blv. No: 44, 06230 Ankara, Turkey
| | - Mehmet Fatih Karakuş
- Department of Otorhinolaryngology, Health Sciences University, Ankara Numune Training and Research Hospital, Talatpaşa Blv. No: 44, 06230 Ankara, Turkey
| | - Aykut İkincioğulları
- Department of Otorhinolaryngology, Health Sciences University, Ankara Numune Training and Research Hospital, Talatpaşa Blv. No: 44, 06230 Ankara, Turkey
| | - Kürşat Murat Özcan
- Department of Otorhinolaryngology, Health Sciences University, Ankara Numune Training and Research Hospital, Talatpaşa Blv. No: 44, 06230 Ankara, Turkey
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Lelii M, Senatore L, Amodeo I, Pinzani R, Torretta S, Fiori S, Marchisio P, Bosis S. Kikuchi-Fujimoto disease in children: two case reports and a review of the literature. Ital J Pediatr 2018; 44:83. [PMID: 30021595 PMCID: PMC6052688 DOI: 10.1186/s13052-018-0522-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/02/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Kikuchi-Fujimoto disease is a rare, idiopathic and generally self-limiting cause of lymphadenitis of unknow etiology with a low recurrence rate. The typical clinical signs are cervical lymphadenopathy, fever, and symptoms of respiratory infection, and less frequently chills, night sweats, arthralgia, rash, and weight loss. CASE PRESENTATION Here we describe two case reports of Kikuchi Fujimoto disease presenting in Milan within the space of a few months. The first involved the recurrence of KFD in a young boy from Sri Lanka; the second was a rare case of severe KFD complicated by HLH. CONCLUSIONS Pediatricians must consider KFD in the differential diagnosis of fever of unknown origin in children, even in western countries. Although rare, recurrence and severe complications are possible. Where symptoms suggest KFD, a systematic diagnostic approach is key. Since no guidelines on the management of KFD are available, further studies should be conducted to investigate the therapeutic options and long term outcome in children.
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Affiliation(s)
- Mara Lelii
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Senatore
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilaria Amodeo
- Neonatal Intensive Care Unit, Università degli Studi di Milano, Fondazione IRCCS Ca’, Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Raffaella Pinzani
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Torretta
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Fiori
- Division of Pathology, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Marchisio
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Samantha Bosis
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Cunnane M, Cheung L, Moore A, di Palma S, McCombe A, Pitkin L. Level 5 Lymphadenopathy Warrants Heightened Suspicion for Clinically Significant Pathology. Head Neck Pathol 2016; 10:509-512. [PMID: 27260216 PMCID: PMC5082057 DOI: 10.1007/s12105-016-0733-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 05/22/2016] [Indexed: 12/31/2022]
Abstract
We conclude that patients presenting with level 5 lymphadenopathy should be investigated with heightened clinical vigilance. Our results suggest that up to 80 % will harbour clinically significant pathology requiring further medical treatment, three quarters of which will be malignancy. We report an observational study of histological outcomes of level 5 lymph node biopsies from a regional histopathology department across 5 years. 184 subjects were identified as having a biopsy of a lymph node from the level 5 region within the study period. One hundred and fifty six cases (84.8 %) had clinically significant pathology on final histology requiring further medical treatment. Lymphoma accounted for the highest number of cases (n = 72, 39.1 %), followed by metastatic carcinoma (n = 65, 35.3 %) and granulomatous change (n = 17, 9.2 %). Gender and laterality were not shown to be independent predictors of pathology significance (p > 0.05).
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Affiliation(s)
- M. Cunnane
- Royal Surrey County Hospital NHS Trust, Egerton Road, Guildford, Surrey GU2 7XX UK
| | - L. Cheung
- Royal Surrey County Hospital NHS Trust, Egerton Road, Guildford, Surrey GU2 7XX UK
| | - A. Moore
- Royal Surrey County Hospital NHS Trust, Egerton Road, Guildford, Surrey GU2 7XX UK
| | - S. di Palma
- Royal Surrey County Hospital NHS Trust, Egerton Road, Guildford, Surrey GU2 7XX UK
| | - A. McCombe
- Frimley Park Hospital NHS Trust, Portsmouth Road, Frimley, Surrey GU16 7UJ UK
| | - L. Pitkin
- Royal Surrey County Hospital NHS Trust, Egerton Road, Guildford, Surrey GU2 7XX UK
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Al Kadah B, Popov HH, Schick B, Knöbber D. Cervical lymphadenopathy: study of 251 patients. Eur Arch Otorhinolaryngol 2014; 272:745-52. [PMID: 25294051 DOI: 10.1007/s00405-014-3315-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 09/26/2014] [Indexed: 02/05/2023]
Abstract
Correct diagnosis of cervical lymphadenopathy is often a great challenge. The objective of this case study is to describe the distribution of the most common causes of unclear neck swellings presented in an ENT-Department and to evaluate the clinical history, examination and laboratory findings. In a retrospective study at the Department of Otorhinolaryngology, University Medical Center Homburg/Saar, 251 patients were enrolled with clinical and ultrasound signs of cervical lymphadenopathy as well as lymph node extirpation for histopathological evaluation. 127 patients (50.6 %) had a histological malignant finding. The distribution of the most common pathological conditions was as follows: Non-specific reactive hyperplasia n = 89 (35.5 %), metastases n = 86 (34.3 %), lymphoma n = 41 (16.3 %), granulomatous lesions n = 15 (6 %), abscess formations n = 5 (2 %), necrotic lymphadenitis and Castleman's disease one case of each, lymph node with normal architecture n = 7 (2.8 %), and neck masses mimicking lymphadenopathy n = 6 cases (2.4 %). The following factors identified by multivariate logistic regression were significantly associated to malignant lymphadenopathy: increasing age, generalized lymphadenopathy and history of malignant disorder, fixed neck masses and increasing diameter in ENT examination, bulky lesion, absence of hilus, blurred outer contour, protective role of the long form and decreasing Solbiati-index values by ultrasound B-Mode gray scale examination. Level II contained more benign lymphatic lesions, while the malignancy rate in level IV and V was enhanced. Laboratory parameters significantly associated to malignancies were CRP, LDH and thrombocytopenia. Patients with persisting cervical lymphadenopathy and over 3 weeks of antibiotic treatment should be considered for early biopsy, especially if some of the risk factors, pointed out in this study, are present.
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Affiliation(s)
- Basel Al Kadah
- Department of Otorhinolaryngology, University Medical Center, Kirrberger Street, 66421, Homburg/Saar, Germany,
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