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Clinical Challenge
Pathology
September 2018

Bilateral Painless Cervical Lymphadenopathy in a Child

Author Affiliations
  • 1Texas A&M College of Medicine, College Station
  • 2Department of Pathology, Baylor Scott and White Hospital, Temple, Texas
  • 3Department of Otolaryngology, Baylor Scott and White Hospital, Round Rock, Texas
JAMA Otolaryngol Head Neck Surg. 2018;144(9):840-841. doi:10.1001/jamaoto.2018.1579

A child younger than 10 years presented with an 8-week history of bilateral cervical lymphadenopathy unresponsive to a 10-day course of Augmentin (GlaxoSmithKline). The patient’s parents denied any associated fevers, chills, night sweats, sore throat, abdominal pain, or weight changes. Medical history was noncontributory.

Physical examination showed bilateral, mobile, nontender cervical lymphadenopathy without erythema or swelling. Tonsils were symmetric and not enlarged. There was no noticeable thyromegaly or nodules. Laboratory testing was significant for an elevated erythrocyte sedimentation rate (37 mmol/h). Ultrasonography demonstrated cervical lymphadenopathy bilaterally with the largest node measuring 3.8 cm in maximum dimension. Lymph node needle core biopsy demonstrated increased histiocytes and numerous plasma cells on tissue section (Figure, A). Scattered neutrophils and rare giant cells were also present. Findings of Grocott methenamine silver, acid-fast, and Warthin-Starry stains were negative. The CD-68 immunostain showed numerous histiocytes. The specimen stained positive for CD-30 and S-100 immunostains showing emperipolesis (Figure, B and C). Findings of a CD1a stain were negative. Lymphoid markers by flow cytometry showed a polyclonal mixed B-cell and T-cell population.

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