Cervical adenopathy remains a current problem in pediatrics. Although most of the cases have an infectious or benign etiology, it is important. Cette étude prospective menée du 1er Septembre au 31 Août chez 75 patients reçus pour adénopathies cervicales chroniques dans le service. Get this from a library! Les adénopathies cervicales néoplasiques.. [Y Cachin].
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Cervical lymphadenopathy – Wikipedia
This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Distinguishing between benign and malign adenopathies remains a challenge and could represent a source of error in a diagnosis.
We report a case of right laterocervical adenopathy in a year-old teenager admitted to hospital with an episode of fever associated with dysphagia, congested pharynx, and pultaceous deposits. Initially the adenopathy was considered to be secondary to a coinfection with Streptococcus B-hemolytic and Epstein-Barr virus, as suggested by the positive bacteriological and serological tests. The onset of the adenopathy before the episode and the ultrasound modifications raised the suspicion of a malignancy, later confirmed by the histopathologic examination of the lymph node excision.
The final diagnosis was nodal metastasis of an undifferentiated lymphoepithelial carcinoma with an ENT starting point.
Currently, the adolescent is hospitalised in the ENT ward, where the pharynx carcinoma with nodal metastasis was confirmed. Sometimes the infectious context can mask or unmask a malign chronic disease with insidious evolution.
Cervical adenopathy remains adenopsthies current problem in pediatrics. Although most of the cases have an infectious or benign etiology, it is important for the doctor to be vigilant and to exclude the rare cases or the neoplastic diseases, for a prompt diagnosis and optimum therapeutic decision.
The etiology of cervical adenopathies is complex, varying between benign causes, malign causes, and nodal metastasis. Malign causes include leukemias, lymphomas, neuroblastoma, and rhabdomyosarcoma. Lastly, nodal metastasis of nasopharyngeal carcinoma, thyroid cancer, or parathyroid tumors can occur [ 1 — 9 ]. The lymphoepithelial carcinoma of the pharynx is a malignity that is histologically characterised by an undifferentiated carcinoma with intermixed reactive lymphoplasmacytic infiltrate, seldom encountered in childhood [ 10 ].
Journal de la Recherche Scientifique de l’Université de Lomé
Rapid elucidation of the etiology allows a treatment with optimum effect. FLE year-old male from an urban environment is admitted to hospital in September for fever, unwellness, and dysphagia. The results of the laboratory tests are as follows: The first ENT examination revealed pseudomembranous tonsillitis.
Therefore, infectious mononucleosis was suspected. Asenopathies ultrasound, gray scale mode B, of the cervical mass showed a well-defined adenopathy adenopatuies The lymph node is round, well defined, hypoechoic, and with intranodal calcification and no echogenic hilus Figure 2. The correlation between the clinical and laboratory data for the actual episode raised the suspicion of a coinfection with Beta-hemolytic Streptococcus and Epstein-Barr virus.
Hence, the cercicales was given penicillin for 10 days. This led to an obvious improvement of the symptoms as follows: The previous history of the adenopathy that appeared 6 months before the infectious episode with uneven evolution and malignancy characteristics required a lymph node biopsy, as highlighted by the lymph node ultrasound.
Figure 3 shows the intraoperative aspects during lymph node excision. The following observations were made: The histopathologic examination suggests cergicales presence of a lymph cervicqles metastasis of an undifferentiated lymphoepithelial carcinoma with an ENT starting point. Currently, the teenager is hospitalised in the ENT ward, where the diagnosis of pharynx carcinoma with nodal metastasis was confirmed by endoscopy and biopsy.
No evidence of metastasis in other areas was found. The thoracic and abdominal MRI was normal. The apparent acute evolution, the onset with high fever, dysphagia, pseudomembranous tonsillitis, the right laterocervical location, and the favourable response to the antibiotic treatment initially suggested an infectious etiology with intricate elements of streptococcal and infectious mononucleosis.
Case Reports in Pediatrics
No hepatosplenomegaly was detected and no associated adenopathies were recorded. The elements that suggested malignity were the onset of the adenopathy 6 months before, the persistence and the ultrasound aspect of the cervical mass, round shape, Solbiati index lowered below 2, the absence of the echogenic hilus, the aspect of calcification inside the lymph node, and the hypoechoic mass with hyperechoic echoes.
The Solbiati index SI represents the ratio of the largest to the smallest diameter. Values above 2 are associated with a benign process, whereas values below 2 are correlated with malignancy [ 11 ]. Due to all these elements Table 1 a lymph node biopsy was required. The histopathologic examination confirmed the malignity of the adenopathy.
Lymphoepithelial carcinoma is a rare malignancy in children. None of these cases was of a child, with the average age of the cases being 58—62 years. As a result, being able to distinguish between benign and malign adenopathies is of great interest to the clinician.
Al Kadah et al. The persistence of a cervical adenopathy for more than 3 weeks warrants a biopsy.
This includes 7 criteria: Ahuja and Ying [ 15 ] highlight that the malignancy elements in the cervical adenopathies cervicalds the round shape, absence of hilus, necrosis inside the lymph node, reticulated appearance, calcifications, matting, subcutaneous cellular tissue edema, and peripheric vascularization.
In addition, it must be used to remove the erroneous interpretations resulting from these techniques. However, it could have resulted in a delay of the primary diagnosis by interpreting the cervical mass in the infectious context. The lymph node cegvicales is a useful element that can raise malignancy suspicions even in an apparent benign clinical context.
The authors declare that there is no conflict of interests regarding the publication of this paper. Case Reports in Pediatrics. Indexed in Cervicqles of Science.
Subscribe to Table of Contents Alerts. Table of Contents Alerts. Abstract Distinguishing between benign and malign adenopathies remains a challenge and could represent a source of adenopatjies in a diagnosis. Introduction Cervical adenopathy remains a current problem in pediatrics. Case Report FLE year-old male from an urban environment is admitted to hospital in September for fever, unwellness, and dysphagia.
The ultrasound performed, gray scale mode B of the cervical mass.
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