Lymphadenopathy in children and adolescents: main causes and differential diagnosis of clinical forms

Lymphadenopathy (LAP) in children is a frequent reason for seeking medical attention and can be due to a variety of conditions, including malignant diseases. Objective. To improve the diagnosis of diseases in children and adolescents debuting with LAP syndrome, based on the determination of its causes, differential diagnosis for timely detection of malignant neoplasms. Patients and methods. Over 5 years, the medical records of 4140 children with LAP syndrome were analyzed, of which 474 with unspecified cause at the first visit to the doctor were identified. A comparison of LAP forms according to clinical and diagnostic parameters was performed, allowing differentiation of benign and malignant LAP. Results. LAP in the form of lymphadenitis was detected in 268 (56.5%) children 4-8 years old with infectious pathology, including tuberculosis (30.6%). Reactive hyperplasia of lymph nodes (l/u) was diagnosed in 90 (19%) children 1–7 years old and more often caused by viral infections. Malignant LAP and neoplasms were identified in 47 (9.9%) children 10–15 years of age. The main predictors for the detection of malignant LAP were: combination of l/u characteristics (UOR 74.43 [22.96; 241.36]), supraclavicular/subclavicular LAP (UOR 18.89 [7.47; 47.75]), hepatomegaly (UOR 13.49 [3.37; 54.05]), presence of l/u immobility (UOR 11.86 [5.08; 27.72]), B-symptoms (UOR 10.37 [2.01; 53.60]) and generalized nature of LAP (UOR 9.26 [4.50; 19.07]). Conclusion. The identified clinical predictors of malignant LAP should contribute to earlier diagnosis of malignant disease in children.