Serdar Bozlak1, Muhammet Ali Varkal2, Ismail Yildiz3, Sadik Toprak4, Serap Karaman5, Oguz Bülent Erol6, Ensar Yekeler7, Ayşegul Unuvar8, Ayse Kilic9, Fatma Oguz10, Emin Unuvar11. 1. Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Istanbul, Turkey. Electronic address: serdar_bozlak@hotmail.com. 2. Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Division of Ambulatory Pediatrics, Istanbul, Turkey. Electronic address: drmavarkal@yahoo.com. 3. Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Division of Ambulatory Pediatrics, Istanbul, Turkey. Electronic address: drismail810@yahoo.com. 4. Bulent Ecevit University, Faculty of Medicine, Department of Forensic Medicine, Zonguldak, Turkey. Electronic address: sadik_toprak@yahoo.com. 5. Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology & Oncology, Istanbul, Turkey. Electronic address: drkaramans@yahoo.com. 6. Istanbul University, Istanbul Faculty of Medicine, Department of Radiology, Division of Pediatric Radiology, Istanbul, Turkey. Electronic address: erolob@gmail.com. 7. Istanbul University, Istanbul Faculty of Medicine, Department of Radiology, Division of Pediatric Radiology, Istanbul, Turkey. Electronic address: ensaryekeler@gmail.com. 8. Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology & Oncology, Istanbul, Turkey. Electronic address: aysegulu@hotmail.com. 9. Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Division of Ambulatory Pediatrics, Istanbul, Turkey. Electronic address: draysekilic@gmail.com. 10. Istanbul University, Institute of Child Health, Istanbul, Turkey. Electronic address: faoguz2000@yahoo.com. 11. Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Division of Ambulatory Pediatrics, Istanbul, Turkey. Electronic address: eminu@istanbul.edu.tr.
Abstract
AIM: Cervical lymphadenopathy (LAP) is a common sign and may raise fears about serious illnesses. The aim of our study was to evaluate the patients with cervical LAPs in a general pediatrics clinic setting, and to evaluate follow-up results for potential causes and risk factors for malignancies. MATERIAL AND METHODS: Two hundred-eighteen patients aged between 79.4±46.7 months with LAP were enrolled in this prospective cohort study. The patients were examined in terms of demographics, clinical, radiologic and serologic aspects like Epstein-Barr virus (EBV), cytomegalovirus (CMV), parvovirus B19. A lymph node biopsy was performed in selected patients. The patients were followed-up for 8 weeks and risk factors for malignancy were evaluated. RESULTS: Seventy patients (41.3%) had specific etiology and 6 (2.7%) had malignant causes. The causes were as follows: 27% (n=59) infections; 2.7% (n=6) malignancies; 11.4% (n=25) other causes. EBV was responsible for 27% of infectious causes. The other common infectious etiologies were CMV 4.3%, parvovirus B-19 2.9%, and group-A beta-hemolytic streptococcus (GAS) 10.8%. Four of the six malignancies were lymphomas. Predictive factors for malignancy were having LAP larger than 30mm, rubbery lymph node, high serum CRP and LDH values, no hilum in ultrasonography, and enlargement of lymph node in follow-up. High uric acid levels and leucopenia were also common in the malignancy group. CONCLUSION: Etiology of cervical LAPs was diagnosed in 41.3% patients. Infectious causes were the most common cause with 27%. Malignancy was diagnosed in 2.7% and lymphoma was the most common malignancy.
AIM: Cervical lymphadenopathy (LAP) is a common sign and may raise fears about serious illnesses. The aim of our study was to evaluate the patients with cervical LAPs in a general pediatrics clinic setting, and to evaluate follow-up results for potential causes and risk factors for malignancies. MATERIAL AND METHODS: Two hundred-eighteen patients aged between 79.4±46.7 months with LAP were enrolled in this prospective cohort study. The patients were examined in terms of demographics, clinical, radiologic and serologic aspects like Epstein-Barr virus (EBV), cytomegalovirus (CMV), parvovirus B19. A lymph node biopsy was performed in selected patients. The patients were followed-up for 8 weeks and risk factors for malignancy were evaluated. RESULTS: Seventy patients (41.3%) had specific etiology and 6 (2.7%) had malignant causes. The causes were as follows: 27% (n=59) infections; 2.7% (n=6) malignancies; 11.4% (n=25) other causes. EBV was responsible for 27% of infectious causes. The other common infectious etiologies were CMV 4.3%, parvovirus B-19 2.9%, and group-A beta-hemolytic streptococcus (GAS) 10.8%. Four of the six malignancies were lymphomas. Predictive factors for malignancy were having LAP larger than 30mm, rubbery lymph node, high serum CRP and LDH values, no hilum in ultrasonography, and enlargement of lymph node in follow-up. High uric acid levels and leucopenia were also common in the malignancy group. CONCLUSION: Etiology of cervical LAPs was diagnosed in 41.3% patients. Infectious causes were the most common cause with 27%. Malignancy was diagnosed in 2.7% and lymphoma was the most common malignancy.
Authors: Ji Eun Park; Young Jin Ryu; Ji Young Kim; Young Hoon Kim; Ji Young Park; Hyunju Lee; Hyoung Soo Choi Journal: Eur Radiol Date: 2020-03-18 Impact factor: 5.315