Clinical features worrisome for malignancy or granulomatous disease in children with peripheral lymphadenopathy

Systemic symptoms (fever >1 week, night sweats, weight loss [>10% of body weight])

Supraclavicular (lower cervical) nodes

Generalized lymphadenopathy

Fixed nontender nodes in the absence of other symptoms; matted nodes

Nontender lymph nodes >1 cm with onset in the neonatal period

Nontender lymph nodes ≥2 cm in diameter that increase in size from baseline or do not respond to 2 weeks of antibiotic therapy

Abnormal chest radiograph (particularly mediastinal mass or hilar adenopathy)

Abnormal complete blood count (eg, lymphoblasts, cytopenias in more than 1 cell line)

Elevated lactate dehydrogenase

Absence of symptoms in the ear, nose, and throat regions

Persistently elevated ESR/CRP or rising ESR/CRP despite antibiotic therapy

ESR: erythrocyte sedimentation rate; CRP: C-reactive protein.

References:

Lake AM, Oski FA. Peripheral lymphadenopathy in childhood. Ten-year experience with excisional biopsy. Am J Dis Child 1978; 132:357.
Niedzielska G, Kotowski M, Niedzielski A, et al. Cervical lymphadenopathy in children--incidence and diagnostic management. Int J Pediatr Otorhinolaryngol 2007; 71:51.
Oguz A, Karadeniz C, Temel EA, et al. Evaluation of peripheral lymphadenopathy in children. Pediatr Hematol Oncol 2006; 23:549.
Slap GB, Brooks JS, Schwartz JS. When to perform biopsies of enlarged peripheral lymph nodes in young patients. JAMA 1984; 252:1321.
Soldes OS, Younger JG, Hirschl RB. Predictors of malignancy in childhood peripheral lymphadenopathy. J Pediatr Surg 1999; 34:1447.

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