Cervical Lymphadenopathy in Children

Cervical lymphadenopathy is one of the most common complaints for hospital referral in children. In many cases, children have benign cervical lymph node enlargements as an immune response to viral or bacterial infections, or vaccines. Less common reasons are pathological conditions such as suppurative lymphadenitis, granulomatous lymphadenitis, malignancies, Langerhans cell histiocytosis, Rosai-Dorfman disease, and Castleman’s disease that require further investigation. Besides acute suppurative lymphadenitis, children may undergo surgical excision to determine possible pathology. In a systematic review of pediatric cervical lymphadenopathy, nonspecific benign etiology is present in 67.8% while Epstein-Barr virus in 8.86%, malignancy 4.69%, and granulomatous disease 4.06%. Lymph nodes are immune surveillance points of the immune system. Afferent lymphatics bring antigen-loaded dendritic cells to the lymph node, and they present their antigens to T cells in the paracortical areas of the lymph node. Then, T cells begin to differentiate and proliferate. T cells stimulate B cells, and then they become plasma cells to secrete antibodies. Later, CD4+ and CD8+ effector cells and antibody reach the inflammation-infection site via effect lymphatics and blood circulation.