Background: Lymphadenopathy (LY) is a common clinical sign (local or systemic) of infections in children; however, it can be an important sign of malignant disease. The definition and approach to NRTLY is problematic and debatable. Referral for biopsy is generally necessary in situations of progressive LY or if no signs of regression are present over a period of 4 weeks. Objectives: To characterize the etiologic, diagnostic, microbiological, clinical and therapeutic aspects of NRTLY requiring a diagnostic biopsy in children aged 0-18 years.
Patients and Methods: NRTLY was defined as LY not improving after a 4 weeks-conservative treatment period. The medical records and hematology, chemistry, microbiology and pathology laboratories and operating room files of all children diagnosed with NRTLY were reviewed. Patients were classified by etiology and divided into 4 main groups: LY from infections etiology, LY due to benign tumors, LY due to malignant tumors and LY with no definitive histological diagnosis.
Results: A total of 143 infants and children with NRTLY were studied. Most of the children were male (65%); there were 47.6% Jewish and 52.4% Bedouin children. There were 4.8%, 37.8%, 20.3% and 37.1% patients aged <1 year, 1-5 years, 5-10 years and >10 years of age, respectively). Most cases (60.8%) had an infectious disease; a specific microbiological diagnosis was made in 14 patients. There were 5 cases of non tuberculous mycobacteria, 2 Staphylococcus spp. (1 methicillin susceptible, 1 MRSA), 1 of Mycobacterium tuberculosis, 1 of Acinetobacter spp., 2 of Toxoplasma gondii, 2 of EBV and 1ofCMV. In cases without identification of a specific pathogen, the biopsy finding in the biopsies were described as “non-specific inflammation”. Malignancies (Hodgkin and non-Hodgkin lymphomas and leukemias) were found in 14.0%, 2.8% and 6.3% cases, respectively. The number of cases with infectious etiology was higher than of cases with malignancies (87/143, 60.8% vs. 33/143, 23.1%, P<0.001). Children with malignancies suffered more from weakness, cough, sweats and weight loss compared with children with infections (P<0.01 for all comparisons). Most NRTLY were localized in the cervical region (114, 79.9%).
Conclusions: 1) Most cases of NRTLY occurred as a result of an infectious etiology; 2) A definitive diagnosis was established in only a minority of the patients with infectious etiology; 3) Malignancies were diagnosed in 23.1% patients with Hodgkin lymphoma emerging as the primary malignant disease; 4) Children with malignancies suffered more from specific clinical signs and symptoms compared with children with infection-related NRTLY.
