Venturini Elisabetta, Grillandini Chiara, Bianchi Leila, Montagnani Carlotta, Chiappini Elena, Galli Luisa
Division of Pediatric Infectious Disease, Anna Meyer Children's University Hospital, Florence, Italy.
Department of Health Sciences, University of Florence, Florence, Italy.
J Paediatr Child Health. 2020 Aug;56(8):1277-1282. doi: 10.1111/jpc.14922. Epub 2020 May 21.
The aim of the present study is to describe the clinical features and outcomes of childhood lymphadenopathy and to define factors able to predict neoplastic aetiology or may improve its prognosis.
All children evaluated for lymphadenopathy in our tertiary children's hospital and who underwent their first examination between 1 January, 2015 and 31 December, 2017 were enrolled in this retrospective observational study. Data were analysed using SPSS.Statistics, 24.0.
A total of 322 children, aged between 0 and 18 years (median 4.5; interquartile range 2.5-9), were enrolled. A specific diagnosis was achieved in almost half of the cases (n = 159, 49.4%) by using one or more methods, including serological, microbiological, biomolecular or histological investigations on surgical samples. Epstein Barr virus and non-tuberculous mycobacteria were the most common etiological agents among acute/sub-acute and chronic lymphadenopathy, respectively. At the end of the study period, two-thirds (210, 65.2%) of enrolled patients were successfully treated. Malignancies and non-tuberculous mycobacteria infections had the longest time to resolution.
Our data suggest that lymphadenopathy is a benign condition in most cases. Of note in our study, 2.5% of lymphadenopathy cases were found to be due to oncologic conditions. The most frequent infective causes were Epstein Barr virus, bacteria and non-tuberculous mycobacteria infections. No haematic or ultrasonographic features were independently able to provide sufficient evidence for a conclusive diagnosis. However, utilising these findings alongside evaluation for clinical criteria can guide decision-making for physicians. Lymphadenectomy is the most appropriate process to follow in the event of chronic lymphadenopathy with undefined diagnosis.
本研究旨在描述儿童淋巴结病的临床特征和结局，并确定能够预测肿瘤病因或改善其预后的因素。
在我们的三级儿童医院接受淋巴结病评估且于2015年1月1日至2017年12月31日期间接受首次检查的所有儿童均纳入本回顾性观察研究。使用SPSS Statistics 24.0分析数据。
共纳入322名年龄在0至18岁之间（中位数4.5；四分位间距2.5 - 9）的儿童。通过对手术样本进行一种或多种检查方法，包括血清学、微生物学、生物分子或组织学检查，几乎一半的病例（n = 159，49.4%）获得了明确诊断。在急性/亚急性和慢性淋巴结病中，爱泼斯坦-巴尔病毒和非结核分枝杆菌分别是最常见的病原体。在研究期结束时，三分之二（210，65.2%）的纳入患者得到成功治疗。恶性肿瘤和非结核分枝杆菌感染的缓解时间最长。
我们的数据表明，在大多数情况下，淋巴结病是一种良性疾病。在我们的研究中值得注意的是，2.5%的淋巴结病病例被发现是由肿瘤性疾病引起的。最常见的感染原因是爱泼斯坦-巴尔病毒、细菌和非结核分枝杆菌感染。没有血液学或超声特征能够独立提供足够的证据进行确诊。然而，将这些发现与临床标准评估相结合可以指导医生的决策。对于诊断不明确的慢性淋巴结病，淋巴结切除术是最合适的后续处理方法。
