Pattern of acquired neck masses in a Kenyan paediatric population

Abstract

Acquired paediatric neck masses constitute a diagnostic challenge. Their pattern is important in formulating management protocol. Reports from developing countries including Kenya are scarce. This study describes the causes, location, clinical features and gender distribution of these masses in a Kenyan paediatric population. This prospective cross-sectional study was carried out in a regional Eastern and Central African referral centre in Kenya. Children aged 16 years and below with neck masses, who presented to various clinics and wards in a 5 month period were examined. One hundred and eighty four of 235 masses (78%) were acquired. Inflammatory cases were the most common (64%), followed by malignant neoplasm (32%). The most common inflammatory cases were abscesses, reactive lymphadenopathy and tuberculous adenitis. They mainly involved upper cervical and submandibular lymph nodes and were more prevalent in those aged less than 4 years. Lymphomas were the most common malignant masses (42%). Malignant masses were widespread in location; non-tender, and most frequent in those aged 4–8 years. In conclusion, inflammatory conditions consistent with upper airway infection cause most acquired paediatric neck masses, but malignant neoplasms constitute a significant proportion. Prudent management of infection and early confirmation of diagnosis are recommended.

Neck masses in children are reported infrequently . Despite being frequent, they constitute a diagnostic challenge . Establishing the characteristics of these masses, including cause, location, clinical features, age and gender distribution, is essential for accurate diagnosis and rational management . The aetiology includes congenital malformations, inflammatory and neoplastic conditions . Distribution of these causes varies between countries .

Reports from African populations are scarce and absent from Kenya. This study reports the pattern of acquired neck masses from a sample Kenyan paediatric population.

Patients and methods

This was a prospective cross-sectional study at the largest teaching and regional referral hospital in Kenya. All children aged 16 years and below with neck masses seen at paediatric clinics and wards within the 5 month period between 1 December 2006 and 30 April 2007 were included in the study. Ethical approval was obtained from Kenyatta National Hospital Ethics and Research Committee. The children were divided into males and females and then into 8 age groups of 2 years, beginning from birth. The history of each child was taken, and the neck examined for location, size, consistency, temperature and pulsation of the mass. Diagnostic tests included full haemogram, peripheral blood films, fine needle aspiration for cytology, excisional biopsy and bone marrow aspiration. Only children in whom the diagnosis was confirmed were included in the study. The data gathered were analysed using SPSS version 11.50 and presented in the form of tables and graphs.

Results

Two hundred and thirty five (126 males; 109 females) children aged between 2 days and 16 years were included. One hundred and eighty four (78%) of these had acquired neck masses. Fifteen varieties of recorded masses were categorized into inflammatory, malignant neoplasms, benign neoplasms and non-inflammatory benign lesions. The commonest cause was inflammatory (64%) followed by malignant types (32%) [ Fig. 1 ]. Of the inflammatory causes, abscesses were the commonest (33%) followed by reactive lymphadenopathy (29%) tuberculous adenitis (21%) and HIV associated lymphadenopathy (9%) [ Table 1 ]. Lymphomas were the most common malignant neoplasm (42%) followed by acute lymphocytic leukaemia (24%), nasopharyngeal carcinoma (14%) and neuroblastoma (9%). Kaposi’s sarcoma was the least common (2%) [ Table 2 ]. The benign neoplastic and non-inflammatory benign conditions that were observed are listed in Table 3 .

Fig. 1
Causes of acquired paediatric neck masses.

Table 1
Causes of inflammatory paediatric neck masses.
Cause Count %
Abscess 38 32.5
Reactive lymphadenopathy 34 29.1
Tuberculous adenitis 25 21.4
HIV associated lymphadenopathy 10 8.5
Cellulitis 05 4.3
Ludwig’s angina 04 3.4
Sinus histiocytosis 01 0.8
Total 117 100

Table 2
Causes of malignant paediatric neck masses.
Cause Count %
Hodgkin’s lymphoma 14 23.7
Non-Hodgkin’s lymphoma 11 18.6
Acute lymphocytic leukaemia 14 23.7
Nasopharyngeal carcinoma 08 13.6
Neuroblastoma 05 8.5
Rhabdomyosarcoma 04 6.8
Chronic myeloid leukaemia 02 3.4
Karposi’s sarcoma 01 1.7
Total 59 100

Table 3
Benign non-inflammatory and benign neoplastic conditions.
Condition Count
Non-inflammatory benign lesions Plunging ranula 2
Retention cyst 1
Inclusion cyst 1
Benign neoplastic Pleomorphic salivary adenoma 2
Goitre 2

Inflammatory cases presented mainly with fever, lymph node tenderness, dysphagia and cough. Night sweats and weight loss were common in tuberculous patients. The lymph nodes were mainly in the upper cervical and submandibular regions. In patients with lymphomas, the lymph nodes were multiple, rubbery, firm, mobile, non-tender and were distributed in all regions of the neck. Common symptoms were fever, night sweats and weight loss.

In patients with leukaemia, lymphadenopathy was multiple and associated with fever, night sweats and weight loss. Bloody nasal discharge and easy fatigability were common. The lymph nodes were non-tender, mobile, firm and discrete. In nasopharyngeal carcinoma, the lymph nodes were multiple, firm, non-tender and immobile. Nasal blockage and bloody discharge, hearing loss, halitosis and trismus were notable. HIV associated lymphadenopathy was accompanied by weight loss, loss of appetite and fever. The lymph nodes were bilateral and multiple.

The age at presentation varied with the type of mass. For inflammatory neck masses, the mean age was 5.4 years and those most frequently affected were 0–2 years of age ( Fig. 2 ). For malignant neck masses, the mean age was 7.8 years, with those 4–10 years being the most affected ( Fig. 3 ). The gender distribution varied with the cause. In inflammatory masses, there was a slight male predominance. In case of malignant masses the male predominance was remarkable ( Table 4 ).

Fig. 2
Age distribution of inflammatory masses.

Fig. 3
Age distribution of malignant masses.

Feb 7, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Pattern of acquired neck masses in a Kenyan paediatric population
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