To “B” or not to “B”: Cervical Lymphadenopathy in a Previously Healthy 16-year-old Boy - EAP 2019 Congress and MasterCourse Porto Palacio Hotel

Mafalda Castelao ^1,2 Ana Raquel Claro ¹ Pedro Silva ³ Ana Barbosa Rodrigues ¹ Ana Catarina Amorim ⁴ Ana Isabel Fernandes ^2,5,6 Daniela Macedo ⁵ Isabel Esteves ^1,2 Ana Mouzinho ^1,2 José Gonçalo Marques ^1,2

¹Department of Paediatrics, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Portugal
²Faculty of Medicine, University of Lisbon, Portugal
³Department of Paediatrics, Hospital de Santo André, Centro Hospitalar de Leiria, Portugal
⁴Department of Paediatrics, Hospital Fernando da Fonseca, Portugal
⁵Oncoloy Service, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa, Portugal
⁶IMM, Instituto de Medicina Molecular João Lobo Antunes, Portugal

Background: Lymphadenopathy in children is common and generally benign and self-limited. Specific accompanying systemic symptoms can call for attention for a manifestation of serious underlying disease.

Case description: A 16-year-old male presented to the Emergency Department with a two-month history of a rapidly progressing nontender unilateral cervical mass, with no fever or other complaints. On thorough history, there was an objective weight loss of 8 percent of body weight and increased night sweats over the last few weeks. There were no complaints of pruritus and no past medical history of previous infections, exposures to toxins or evidence of underlying immune deficiencies or familial cancer. On physical examination a localized bulky, firm, rubbery, nontender lymphadenopathy in the lower cervical and supraclavicular region was found. There was no facial edema, dysphagia or dyspnea. He had a clear oropharynx and no evidence of hepatosplenomegaly or skin lesions. His blood tests revealed leukocytosis (22600/uL) with elevated C-reative protein (9,45mg/dL) and sedimentation rate (42mm/h). A CT scan revealed cervical lymphadenopathy in relation with a large mediastinal mass surrounding the aorta, causing complete obstruction of the superior vena cava (SVC) and significant compression of the trachea (axis 5mm). He underwent an excisional biopsy of the lymph node, diagnosing classic Hodgkin Lymphoma (HL). He was referred to Hematology to initiate treatment.

Conclusion: HL is the most common childhood cancer in the 15- to 19-year-old age group. Most patients present with only painless lymphadenopathy, usually cervical or supraclavicular. Seventy-five percent have a mediastinal mass at the time of presentation with risk of SVC syndrome. Nonspecific systemic symptoms including night sweats and weight loss, classified as "B" symptoms, are important indicators of malignant disease and warrant a detailed history and complete physical examination for early detection.