Karadeniz C, Oguz A, Ezer U, Oztürk G, Dursun A
Department of Pediatric Oncology, Gazi University, Faculty of Medicine, Beşevler, Ankara, Turkey.
Pediatr Hematol Oncol. 1999 Nov-Dec;16(6):525-31. doi: 10.1080/088800199276813.
This prospective study evaluated 382 pediatric patients with peripheral lymphadenopathy (LA) presenting at the Pediatric Oncology and Hematology Departments of Social Security Children's Hospital and Gazi University Medical Faculty Hospital. The ages of the patients ranged between 2 months and 16 years (median 7 years); 72% of the patients were male. Of the 382 patients, 138 had localized LA (a single anatomic area involved), 171 had limited LA (two or three areas involved), and 73 had generalized LA (four or more anatomic areas involved). The specific etiology (either benign or malign) was defined in 79% of patients with generalized LA. However, in patients with localized LA and limited LA, specific etiology could be identified only in 43 and 53% of patients, respectively. Based on this study, BCG-LA and pyogenic infections are more frequently manifested by localized LA; LA of unknown origin, Hodgkin's disease, tuberculosis, nasopharyngeal carcinoma, and toxoplasmosis are frequently manifested by localized or limited LA; and cytomegalovirus infection (CMV), infectious mononucleous, rubella, acute leukemia, non-Hodgkin's lymphoma are frequently manifested by limited or generalized LA. Out of 382 patients, 196 patients had a maximum lymph node diameter of less than 2 cm. A benign etiology was shown in 159/196 of these patients. In 37/196 of these patients LA was due to a malignancy, and these cases almost invariably had some apparent additional diagnostic clinical and laboratory findings. Based on this observation a maximum lymph node size of 2 cm was considered an appropriate limit to distinguish malignant disease from benign causes except when there is other evidence of an underlying malignant disease. However, lymphadenopathies located at supraclavicular region (27 patients) either localized or as part of generalized LA had a specific benign or malignant disease in etiology (malignancy in 20, tuberculosis in 3, CMV in 2, sarcoidosis in 1, and lipoma in 1) even though they were less than 2 cm in diameter.
这项前瞻性研究评估了在社会保障儿童医院和加齐大学医学院医院儿科肿瘤学和血液学部门就诊的382例患有外周淋巴结病（LA）的儿科患者。患者年龄在2个月至16岁之间（中位数为7岁）；72%的患者为男性。在382例患者中，138例患有局限性LA（累及单个解剖区域），171例患有局限性LA（累及两个或三个区域），73例患有全身性LA（累及四个或更多解剖区域）。在79%的全身性LA患者中明确了具体病因（良性或恶性）。然而，在局限性LA和局限性LA患者中，分别仅在43%和53%的患者中可确定具体病因。基于这项研究，卡介苗接种后淋巴结炎（BCG-LA）和化脓性感染更常表现为局限性LA；不明原因的LA、霍奇金病、结核病、鼻咽癌和弓形虫病常表现为局限性或局限性LA；而巨细胞病毒感染（CMV）、传染性单核细胞增多症、风疹、急性白血病、非霍奇金淋巴瘤常表现为局限性或全身性LA。在382例患者中，196例患者的最大淋巴结直径小于2 cm。这些患者中有159/196显示为良性病因。在这些患者中的37/196中，LA是由恶性肿瘤引起的，并且这些病例几乎总是有一些明显的额外诊断性临床和实验室检查结果。基于这一观察结果，除了有潜在恶性疾病的其他证据外，最大淋巴结大小2 cm被认为是区分恶性疾病与良性病因的合适界限。然而，位于锁骨上区域的淋巴结病（27例患者），无论是局限性的还是全身性LA的一部分，在病因上都有特定的良性或恶性疾病（20例为恶性肿瘤，3例为结核病，2例为CMV，1例为结节病，1例为脂肪瘤），即使它们的直径小于2 cm。
