MALIGNANCY
Malignancy accounts for 11% to 24% of the diagnoses, depending on the nature of the group reporting their result. Malignant processes are more common in the age group of 2 to 12 years old and very rare in the age group of less than 2 years old. Malignancy as a cause is also more common in children with chronic generalized lymphadenopathy, nodes greater than 3 cm in diameter, and nodes in the supra-clavicular region. Associated symptoms of night sweats, weight loss, and hepatosplenomegaly also increase the chance of malignancy.
The most common malignancies as a cause of lymphade-nopathy are Hodgkin and non-Hodgkin lymphomas, leukemia, and metastatic disease.
Differential Diagnosis of Lymphadenopathy in Children (Faisal G. Qureshi and Kurt D. Newman, 2012) | |
Generalized lymphadenopathy: infectious | Viral: CMV, HIV, rubella, varicella, measles, EBV, herpes, hepatitis Bacterial: typhoid, tuberculosis, mycobacterial, syphilis, LGV, leptospirosis, brucellosis Protozoal: for instance, toxoplasmosis, leishmaniasis Fungal: for instance, coccidioidomycosis, Cryptococcus, histoplasmosis Other: syphilis, Lyme disease |
Generalized lymphadenopathy: malignant | Lymphoma, leukemia, neuroblastoma, thyroid tumor, metastasis (e.g., osteosarcoma, glioblastoma) |
Generalized lymphadenopathy: others | Autoimmune disorders: for instance, JRA, SLE, drug reactions, CGD, lymphohistiocytosis, LCH, dermatomyositis Storage disorders: for instance, Gaucher disease, Niemann Pick disease Miscellaneous: Addison disease, Castleman disease, Churg Strauss syndrome, Kawasaki disease, Kikuchi disease, lipid storage disease, sarcoidosis |
Localized lymphadenopathy: infectious | Staphylococcus aureus, group A Streptococcus (e.g., pharyngitis), anaerobes (periodontal disease), acute bacterial lymphadenitis, cat-scratch disease, tularemia, bubonic plague, diphtheria, chancroid, viral URI, mononucleosis, tuberculosis/atypical mycobacterium |
Localized lymphadenopathy: malignant | Lymphoma, leukemia, neuroblastoma, rhabdomyosarcoma, parotid tumor, nasopharyngeal tumor, solid tumor metastasis |
Localized lymphadenopathy: site specific | Cervical: Kawasaki disease Occipital: tinea capitis, pediculosis capitis Preauricular: cat scratch disease, chronic eye infections Supraclavicular: histoplasmosis, coccidioidomycosis Mediastinal: sarcoidosis, cystic fibrosis, histoplasmosis, Axillary: local infection, brucellosis, immunization reactions, JRA Inguinal: syphilis, LGV, diaper rash |
Localized cervical masses: non nodal masses | Mumps, thyroglossal duct, branchial cleft cyst, sternocleidomastoid tumor, cervical ribs, lymphatic malformation, hemangiomas, laryngocele, dermoid cyst |
!!!Generalized lymphadenopathy is defined as enlargement of more than two noncontiguous lymph node groups.