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.

Дата добавления: 2014-10-15