EVALUATION AND MANAGEMENT OF LYMPHADENOPATHY IN CHILD: WHEN SHOULD A MALIGNITY BE SUSPECTED?

• Main Author: Monica Dragomir
• Format: Article
• Language: English
• Published: Amaltea Medical Publishing House 2018-03-01
• Series: Romanian Journal of Pediatrics
• Subjects: lymphadenopathy; cancer; child
• Online Access: https://revistemedicale.amaltea.ro/Romanian_Journal_of_PEDIATRICS/Revista_Romana_de_PEDIATRIE-2018-Nr.1/RJP_2018_1_EN_Art-03.pdf

The lymph nodes are normal structures and some lymph nodes can be palpable in a healthy patient. The presence of abnormal lymph nodes (lymphadenopathy) can be an indication of a serious systemic disease, and the differential diagnosis can be an ample one. The challenge for the family doctor and pediatrician is to distinguish pathological lymphadenopathies from non-pathological ones and to develop a rational approach to assessing lymph node pathology. Due to association with oncological diseases, lymphadenopathy can be a major source of anxiety for parents. It is essential to recognize the moment when the reference to the pediatric oncologist is justified. Although the discovery of lymphadenopathy sometimes raises concerns about a serious illness, it is often the result of benign infectious causes. Most patients can be diagnosed on the basis of careful history and physical examination. Localized adenopathy requires the search for a causal lesion of proximity and the evaluation of other lymph nodes to rule out generalized lymphadenopathy. Generally, lymph nodes with a diameter of more than 1 cm are considered abnormal. Supraclavicular adenopathies are most suggestive of malignancy. An observation period of three to four weeks is prudent in patients with limfadenopathies localized with characteristics of benignity. Generalized adenopathy always involves additional clinical investigations. In cases where lymph node biopsy is indicated, the excisional biopsy of the most affected lymph node is recommended, which will allow the pathologist to establish the diagnosis of certainty.