Patient's question:
My child is 6 years old this year, and the lymph nodes in the neck have been present for three years. At first, only two were on the right side, but last year one also appeared on the left side. The lymph nodes are movable. Is it serious? Do I need surgery?Doctor's answer:
Lymphadenopathy can be classified into localized and generalized lymphadenopathy as follows:I. Localized lymphadenopathy
1. Non-specific lymphadenitis: Due to local infection, the lymph nodes are soft in the acute stage, tender, smooth, and without adhesion. In chronic inflammation, the lymph nodes become harder and may eventually shrink or regress.
2. Lymph node tuberculosis: Commonly occurs in the neck, with hard texture. The nodes may adhere to each other or to surrounding tissues. If caseous necrosis occurs, a fluctuating sensation can be palpated. In advanced stages, tissue damage may form fistulas, leaving scars after healing.
3. Metastatic malignant lymph nodes: Hard texture, smooth or elevated surface, adhesion to surrounding tissues, and poor mobility. Generally painless.
II. Generalized lymphadenopathy
Lymphadenopathy affects the entire body, with varying sizes and no adhesion. It is seen in acute or chronic lymphadenitis, mononucleosis, lymphoma, and various acute or chronic leukemias.
Lymph nodes contain many cells specialized in phagocytosing pathogens, making them important immune organs. Under normal conditions, lymph nodes are small and difficult to palpate. However, when infection occurs in a specific part of the body, bacteria pass through the lymph nodes via lymph fluid, causing swelling and pain in the corresponding lymph node groups. In malignant tumors, metastasis often occurs along lymphatic vessels and proliferates within the nodes, leading to lymphadenopathy.
If enlarged lymph nodes are larger than soybeans, solitary or, and cause crying or pain upon palpation, parents should take it seriously. This is one of the symptoms of many diseases in children. The common diseases include the following four categories:
● Chronic local inflammation, such as tonsillitis, periodontitis, seborrheic dermatitis, and otitis media, can cause swelling of submandibular and posterior auricular lymph nodes. The enlarged nodes are soft and mobile, usually regressing gradually as inflammation subsides.
● Infectious and systemic diseases, such as measles, chickenpox, infectious mononucleosis, and systemic chronic infections, may cause palpable swollen lymph nodes in various superficial parts of the body.
● Tuberculous inflammation: After infection with Mycobacterium tuberculosis, children may experience swollen and painful lymph nodes in the neck, behind the ears, and submandibular region, accompanied by low-grade fever, night sweats, and weight loss.
● Malignant lymphoma: Lymphadenopathy is most common in the neck. Lymphoma is a tumor originating from lymph nodes or lymphoid tissue. Lymphadenopathy in leukemia is systemic but most prominent in the neck, axillae, and inguinal regions. In addition to lymphadenopathy, patients may have anemia, persistent fever, and the presence of large numbers of immature cells in blood and bone marrow. Lymphadenopathy may also occur in connective tissue diseases such as systemic lupus erythematosus. Other examples include allergic reactions and insect bites.
Therefore, lymphadenopathy should not be ignored, especially when nodes persistently swell, and early medical consultation is recommended.