Lymphadenopathy in a series of Egyptian pediatric patients and the role of pathology in the diagnostic workup

Cervical lymph node biopsies in the evaluation of children with suspected lymphoproliferative disorders: Experience in a tertiary pediatric setting

BACKGROUND/PURPOSE

The objectives of this study were: (1) to determine the incidence of lymphoproliferative disorders in a cohort of patients requiring a biopsy at a tertiary pediatric center; and (2) to elucidate the demographic, clinical, laboratory and diagnostic imaging characteristics associated with a malignant diagnosis.

METHODS

A retrospective review of pediatric cervical lymph node biopsies performed between 2012 and 2019 at a tertiary center was undertaken. Demographic data, clinical presentations, laboratory results, diagnostic imaging findings, and pathology results were compiled and analyzed to identify characteristics associated with a malignant diagnosis.

RESULTS

Malignancy was identified in 49.5% of patients (55/111) subjected to a cervical lymph node biopsy. The median age of patients with a benign diagnosis was lower than malignant diagnosis (11.0 vs. 14.0 years, p < 0.01). Mediastinal lymphadenopathy based on chest radiography and/or computed tomography scan was identified in 37/49 malignant cases (75.5%) CONCLUSION: In this retrospective study, 49.5% of biopsies performed at a tertiary pediatric setting yielded a malignant diagnosis. Traditional clinical characteristics such as weight loss, night sweats and nodal texture were not informative when derived retrospectively. The most valuable features identified were increased age, increased long and short axis measurements of the involved node(s), and the presence of mediastinal lymphadenopathy.

LEVEL OF EVIDENCE

Level III.

Fine Needle Aspiration Biopsy of Peripheral Lymph Nodes in Children: Practical Experience in a Tertiary Hospital

BACKGROUND

Peripheral lymphadenopathy occurs often in children; fine needle aspiration biopsy (FNAB) is a commonly performed diagnostic procedure. We describe FNAB use and outcome for peripheral lymphadenopathy in children in a routine clinical setting.

METHODS

A retrospective study done at Tygerberg Hospital, Cape Town of children (<13 years) who had an FNAB for lymphadenopathy from July 2012 to June 2014. Demographic, clinical, treatment and follow-up data were retrieved from patient folders; FNAB and special investigation results were obtained from the laboratory database.

RESULTS

Of the 173 children, the median age was 37 (interquartile range 13-75) months; 20 (11.5%) were HIV positive. Most FNABs were done in the neck (131; 76%) and axillary areas (34; 20%). FNAB provided a result in 165 (95%) cases; in 8 (5%) children FNAB was insufficient for diagnosis. Mycobacterial aetiology was diagnosed in 84 (49%); 49 (58%) were culture-confirmed (37 Mycobacterium tuberculosis, 10 Mycobacterium bovis BCG, 1 both and 1 non-tuberculous mycobacterium). Reactive lymphadenopathy was diagnosed in 56 (32%), neoplastic disease in 6 (3.5%) and other pathology in 19 (11%) cases. Additional special investigations changed FNAB diagnosis or led to an additional diagnosis in 8 (5%) children. Overall, 70/84 (83%) with mycobacterial aetiology and all neoplastic disease cases received the correct treatment. Follow-up appointments were arranged in 144 (83%) patients.

CONCLUSIONS

In a high tuberculosis burden area, a single FNAB provided a diagnosis in most cases in a routine referral setting; FNAB remains a safe and useful investigation. Follow-up of children to initiate appropriate treatment could improve.

LAY SUMMARY

Large swollen lymph nodes, especially in the neck, are a common finding in children. Fine needle aspiration biopsy (FNAB) is a commonly used diagnostic procedure and we looked at how well this procedure works in everyday hospital practice. We identified all children <13 years of age over a 2-year period (2012-2014) who had an FNAB done at Tygerberg Hospital, Cape Town, South Africa, and looked how well this procedure performed and what the doctors did with these children. We found 173 children who had an FNAB done. They were generally young children of around 3 years old. With a single FNAB, we could make a diagnosis in 95% of these children. About half of the children had tuberculosis or complications of a BCG vaccine (both caused by mycobacteria), only 4% had a malignancy of some kind, about a third had reactive lymph nodes (usually other mainly local infectious causes) and the rest had other pathology like abscesses. All malignancies and >80% of the mycobacterial pathology cases were correctly managed; the latter could definitely improve.

Peripheral adenopathies in children - an attempt of clinical morphological profile

AIM

The authors have proposed to assess peripheral adenopathies in a series of hospitalized children in order to identify and define clinical and morphological profiles of different types of lymph node (LN) diseases.

MATERIALS AND METHODS

The studied group consisted of 58 patients less than 18 years of age. The investigation algorithm included: gender, age, site, involvement, side, extension and histopathological (HP) type of LN lesions. Tissue fragments were processed using classical histological techniques (formalin fixation and paraffin embedment) and stained with Hematoxylin-Eosin (HE). In some cases (tuberculous lesions and lymphomas), special stainings (Ziehl-Neelsen) and immunohistochemistry were used. Stratification scales of cases were defined according to each parameter in order to compare the data. All obtained data were assessed individually, compared to each other and with similar data from the literature with the help of a statistical apparatus [χ² (chi-squared) test and analysis of variance (ANOVA) test] in some cases.

RESULTS

The young patients were slightly more frequently boys, of all ages but with a mean age of 10 and half years. The affected LNs belonged most often to neck region, either on the left or on the right side but sometimes bilateral or even on the midline; usually, more than one LN was involved in the area. In most of the cases, the lesions were localized in only one LN area. HP picture was dominated by the inflammatory processes, firstly the nonspecific ones, followed by tuberculosis.

DISCUSSIONS

Our observations fitted, for each parameter, with the wide ranges found in the literature. Comparisons between parameters' variations revealed differences, sometimes significant that we tried to organize in clinical and morphological profiles.

CONCLUSIONS

The assessment of our data allowed us to define some clinical and morphological profiles of different types of adenopathy that, by improvement on studies including larger series, could be of real use in daily pediatric practice.

Successful Introduction of Fine Needle Aspiration Biopsy for Diagnosis of Pediatric Lymphadenopathy

Accurate and rapid diagnosis of extrapulmonary nodal tuberculosis in children is of paramount importance. This retrospective study performed at Tygerberg Hospital using data from the laboratory records between January 1, 2004 and June 30, 2014 demonstrates how since the introduction laboratory-run FNAB service; fine needle aspiration biopsy has become an acceptable and routine diagnostic procedure for triage of pediatric lymphadenopathy.