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Diagnostic aspects of cervical lymphadenopathy in children in the developing world: A study of 1,877 surgical specimens

dc.contributor.authorMoore S.W.
dc.contributor.authorSchneider J.W.
dc.contributor.authorSchaaf H.S.
dc.date.accessioned2011-05-15T16:03:46Z
dc.date.available2011-05-15T16:03:46Z
dc.date.issued2003
dc.identifier.citationPediatric Surgery International
dc.identifier.citation19
dc.identifier.citation4
dc.identifier.issn1790358
dc.identifier.other10.1007/s00383-002-0771-x
dc.identifier.urihttp://hdl.handle.net/10019.1/12773
dc.description.abstractChronic cervical lymphadenopathy is a common clinical problem frequently requiring surgical biopsy. To evaluate the characteristics of surgically excised cervical lymph nodes (LN) in children in a developing country, we studied 1,332 children less than 15 years old (1,877 surgically removed cervical LNs) over a 23-year period (1976-1999). Indications for biopsy included failure to respond to antibiotic therapy, rapid increase in size, hard, matted LNs in the preauricular, supraclavicular, and posterior triangle of the neck, and difficulty in diagnosis. Clinical and pathological characteristics investigated included age, malignancy, and granulomatous disease such as tuberculosis (tbc). The mean age was 7 years (tbc 5.8/neoplastic disease 8.5 years). Twenty LNs (1.5%) were histologically normal. There were 637 (47.8%) with nonspecific reactive lymphoid hyperplasia and 484 with chronic granulomatous changes (36.3%). Tuberculous lymphadenitis was confirmed in 332 of these (25%). In 181 (54.5%) Mycobacterium tuberculosis was cultured and a further 149 had acid-fast bacilli. Other granulomatous diseases identified included sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfmann disease) (3), syphilis (4), yaws (2), and toxoplasmosis (1). No mycobacteria other than M. tuberculosis were encountered. More than two-thirds (108) of 154 patients with neoplastic LN involvement had a lymphoma; in a further 10 lymphadenopathy was associated with leukemia. Pyogenic organisms were identified in 32, and 5 were positive for human immunodeficiency virus, 1 of whom had Kaposi's sarcoma. A second pathology was identified in 18 of the 637 cases of reactive lymphoid hyperplasia (3 with tuberculosis); in 15 (1.3%) a diagnosis of lymphoma was made from other sites (pleural fluid, etc.) within 6 months of initial biopsy. This represents a diagnostically difficult subgroup requiring further investigation. Chronic lymphadenopathy in children in developing countries has a high incidence of infective causes, including a significant incidence of M. tuberculosis. The incidence of serious pathology in more than one-half of the cervical LNs examined justifies aggressive surgical investigation.
dc.subjectacid fast bacterium
dc.subjectadolescent
dc.subjectage
dc.subjectantibiotic therapy
dc.subjectarticle
dc.subjectbacterium culture
dc.subjectbacterium identification
dc.subjectcancer diagnosis
dc.subjectcervical lymph node
dc.subjectchild
dc.subjectchronic disease
dc.subjectclinical feature
dc.subjectcontrolled study
dc.subjectdeveloping country
dc.subjectdiagnostic procedure
dc.subjectdifferential diagnosis
dc.subjectfemale
dc.subjectgranulomatosis
dc.subjecthardness
dc.subjecthistopathology
dc.subjecthuman
dc.subjectHuman immunodeficiency virus 1
dc.subjectHuman immunodeficiency virus infection
dc.subjectincidence
dc.subjectinfant
dc.subjectinfection
dc.subjectKaposi sarcoma
dc.subjectleukemia
dc.subjectlymph node biopsy
dc.subjectlymphadenectomy
dc.subjectlymphadenopathy
dc.subjectlymphoid hyperplasia
dc.subjectlymphoma
dc.subjectmajor clinical study
dc.subjectmale
dc.subjectmalignant neoplastic disease
dc.subjectMycobacterium tuberculosis
dc.subjectorgan size
dc.subjectpathology
dc.subjectpleura fluid
dc.subjectpriority journal
dc.subjectRosai Dorfman disease
dc.subjectsinus histiocytosis
dc.subjectStreptococcus pyogenes
dc.subjectsyphilis
dc.subjecttoxoplasmosis
dc.subjecttreatment failure
dc.subjecttuberculosis
dc.subjecttuberculous lymphadenitis
dc.subjectyaws
dc.subjectBiopsy, Needle
dc.subjectChild
dc.subjectChild, Preschool
dc.subjectFemale
dc.subjectHumans
dc.subjectLymph Nodes
dc.subjectLymphadenitis
dc.subjectLymphatic Diseases
dc.subjectLymphoma
dc.subjectMale
dc.subjectSouth Africa
dc.titleDiagnostic aspects of cervical lymphadenopathy in children in the developing world: A study of 1,877 surgical specimens
dc.typeArticle
dc.description.versionArticle


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