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Dr. Andrew Rynne

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8 years old with lymphadenitis. High WBC count. Need of biopsy and treatment?

DOCTOR OF THE MONTH - Sep 2012
Sep 2012
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General & Family Physician
Practicing since : 2008
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My child is 8 years old and two months back i noticed lymphadenitis - 3 posterior cervical lymph nodes enlarged.. 1 is 1 cm in size and the other 2 less then 1 cm. i took her to the padeatrician and he asked me to do various blood tests and the TB test . in the blood test the wbc count was very high at that time and the TB test was negative. the doctor asked me to XXXXXXX a padietric surgeon and i took my child there. the surgeon asked me to wait for some time before going in for a excision biobsy. i waited for a month and the enlarged node got smaller and is very much less than 1 cm. now the doctor has asked me to consult him after 1 month. i am not giving any medicine to my child right now. i am getting worried.
Wed, 26 Dec 2012 in Cancer
 
 
Answered by Dr. Das Arindam 1 hour later
Hello,
Thank you for posting a question.

Firstly, some important points should be cleared
1. Did the child had any oral ulcer?
2. Did the child had any other abnormality ?
3. What was the details of differential count of WBC ? Was the neutrophils increased? Did the blood report indicate presence of any atypical cells ? What was the lymphocyte count?

This type of enlarged lymph nodes and presence of high WBC count is seen in infections that may be viral or bacterial, or in leukemic conditions. I think she should be examined thoroughly for any palpable lymph nodes in any other sides, palpable spleen or liver, and any history of bleeding through gum and nose should be noted. All these indicates a possibility of neoplastic conditions.

As the lymph nodes are now became smaller, it denotes a very high possibility of infective conditions. If the neutrophils are increased, it definitely supports, bacterial infection. If lymphocytes are increased that denotes a viral infection. If any abnormal cells are seen that indicates any neoplastic conditions.

One more point is Fine needle aspiration cytology. It replaces the need of urgent excisional biopsy. When the lymph nodes were enlarged, FNAC was a better option for differentiating the neoplastic and infective conditions. It is rapid and effective. Even now, FNAC can be done if the lymph node becomes larger than 1cm again. But before that , infective conditions should be excluded from the complete blood count report.

Right now, no medicine is required. But , one course of antibiotics should be given if infection if infection is detected.

So, consult with a pediatrician or treating doctor to rule out infective conditions and to follow up the complete blood counts again if required.


Hope this information suffices. Let me know, if you have any more question.

Regards.
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