Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지

Clinical Evaluation of Tissue Biopsy for Children with Neck Mass; A Single Center Study

조직검사를 시행한 소아 경부 종류의 임상적 고찰 : 단일 기관 연구

  • Youn, You Sook (Department of Pediatrics, College of Medicine, Chungnam National University) ;
  • Yun, Hye Won (Department of Pediatrics, College of Medicine, Chungnam National University) ;
  • Kim, Sun Young (Department of Pediatrics, College of Medicine, Chungnam National University) ;
  • Sul, Ji Yeong (Department of Surgery, College of Medicine, Chungnam National University) ;
  • Song, Chang Jun (Department of Radiology, College of Medicine, Chungnam National University) ;
  • Kim, Jin Man (Department of Pathology, College of Medicine, Chungnam National University) ;
  • Park, Kyung Duk (Department of Pediatrics, College of Medicine, Chungnam National University)
  • 윤유숙 (충남대학교 의과대학 소아과학교실) ;
  • 윤혜원 (충남대학교 의과대학 소아과학교실) ;
  • 김선영 (충남대학교 의과대학 소아과학교실) ;
  • 설지영 (충남대학교 의과대학 외과학교실) ;
  • 송창준 (충남대학교 의과대학 방사선과학교실) ;
  • 김진만 (충남대학교 의과대학 조직병리학교실) ;
  • 박경덕 (충남대학교 의과대학 소아과학교실)
  • Received : 2005.03.07
  • Accepted : 2005.05.02
  • Published : 2005.08.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose : Neck masses, in pediatric population, derive from a multitude of congenital, inflammatory, or neoplastic diseases. The majority of these masses represent benign conditions. However, thorough clinical evaluation is required to rule out malignant diseases. We evaluated the causes, clinical characteristics and outcomes of children with neck masses who underwent tissue biopsy. Methods : A total of 28 medical records of children with neck mass who underwent tissue biopsy at Chungnam National University Hospital, from January 2000 to March 2004 were retrospectively analyzed. The methods of biopsy were ultrasonography guided core biopsy(CB), fine needle aspiration biopsy(FNAB) and excisional biopsy. Results : Out of 28 patients, half were boys. The most common location of the mass was the posterior cervical area(N=19, 67.9%). Laboratory findings of peripheral blood and serologic studies were nonspecific. In 25(89.3%) cases, CB or FNAB was initially performed for neck masses. Among them 10 cases(40%) were reactive hyperplasia, 8(32%) inflammatory granulation tissues, 4(16%) necrotizing lymphadenitis, and 3(12%) acute suppurative inflammations. Initially, excisional biopsy was performed for diagnosis in 3(10.7%) cases. Diagnosis of these cases was thyroglossal duct cyst, dermoid cyst and lymphoblastic lymphoma, respectively. Conclusion : Most neck masses in children were benign. CB and FNAB were safe methods for tissue sampling, without need for general anesthesia.

목 적 : 소아에서 경부 종류는 다양한 원인에 의해 나타나는데 대부분이 양성 경과를 보이며, 감염에 의한 염증성 반응인 경우가 많지만 선천성 낭종이나 악성 종양의 가능성도 있어 주의를 요한다. 본 연구에서는 경부 종류를 주소로 내원하여 조직검사를 시행한 환아들에서 그 원인과 임상 양상, 치료 경과를 알아보고자 하였다. 방 법 : 2000년 1월부터 2004년 3월까지 충남대학교병원 소아과에 경부 종류를 주소로 내원하여 조직검사를 시행 받았던 환아 28례의 진료 기록을 중심으로 후향적으로 연구하였으며 조직검사 방법을 세침 흡인생검술, 심부생검술, 절제생검으로 나누어 연령, 성별, 임상 양상 및 조직검사 결과와 치료에 대한 반응 등을 조사하였다. 결 과 : 조직검사를 받은 환아들은 총 28례로 남아가 14례(50%), 여아가 14례(50%)였고 종류의 위치로 구분하면 목빗근 뒷부위가 19례(67.9%)로 가장 많았다. 말초혈액 검사나 혈청학적 검사 등의 검사실 검사 상 특이할만한 의미 있는 소견은 없었다. 세침 흡인생검술과 심부생검술을 먼저 시행 받은 환아들은 25례(89.3%) 있었는데 반응성 증식인 경우가 10례(40%)로 가장 많았고 육아종성 염증상태가 8례(32%), 괴사성 염증을 보였던 환아들은 4례(16%), 화농성 병변을 보였던 경우가 3례(12%) 있었다. 처음부터 절제생검을 하였던 환아들은 3례(10.7%)로 선천성 이상에 의한 갑상설관 낭과 표피 낭종이 있었으며 1례는 림프아구성 림프종으로 진단되었다. 결 론 : 소아에게서 흔하게 나타나는 경부 종류는 그 원인이 다양하지만 대부분 양성 경과를 보이며 세침 흡인생검술과 심부생검술은 전신 마취를 하지 않고도 안전하게 조직을 얻을 수 있는 방법으로 치료적 절제가 필요한 경우를 제외하고는 경부 종류의 조직을 얻어 조기에 진단하고 치료하는데 도움이 되고 있다.

Keywords

Acknowledgement

Supported by : 충남대학교병원

References

  1. Donovan K, Joshua E. A neck mass in a young child. Clin Pediatr 2001;40:673-5 https://doi.org/10.1177/000992280104001205
  2. Park YW. Evaluation of neck masses in children. Am Fam Physician 1995;51:1904-12
  3. Timothy R, Kathryn M. Cervical lymphadenopathy and adenitis. Pediatr Rev 2000;21:399-404
  4. Joan P. Cervical adenopathy. Pediatr Rev 1994;15:276-84 https://doi.org/10.1542/pir.15-7-276
  5. Torsiglieri AJ, Tom LW, Ross AJ 3rd, Wetmore RF, Handler SD, Potsic WP. Pediatric neck masses : guidelines for evaluation. Int J Pediatr Otorhinolaryngol 1988;16:199-210 https://doi.org/10.1016/0165-5876(88)90031-6
  6. Knight PJ, Mulne AF, Vassy LE. When is lymph node biopsy indicated in children with enlarged peripheral nodes? Pediatrics 1982;69:391-6
  7. Oski FA. Lymphadenopathy. In : Kaye R, Oski FA, Barness LA, et al., eds. Core textbook of pediatrics. 3rd ed. Philadelphia : Lippincott, 1989:80-3
  8. Friedberg J. Clinical diagnosis of neck lumps : a practical guide. Pediatr Ann 1988;17:620-8
  9. Chesney PJ. Cervical lymphadenopathy. Pediatr Rev 1994; 15:276-84 https://doi.org/10.1542/pir.15-7-276
  10. Edmund S, Joseph M, Sculerati N, Horace C. Fine needle aspiration biopsy of pediatric head and neck masses. Int J Pediatr Otorhinolaryngol 2001;60:135-40 https://doi.org/10.1016/S0165-5876(01)00522-5
  11. Hassan H, Mark K, Carole B. Fine needle aspiration of head and neck masses in children. Am J Otolaryngol 1997; 18:400-4 https://doi.org/10.1016/S0196-0709(97)90061-2
  12. Margileth A. Sorting out the causes of lymphadenopathy. Contemp Pediatr 1995;12:23-40
  13. Larsson L, Bentzon M, Berg Kelly K, Mellander L, Skoogh B, Stranegard IL, et al. Palpable lymph nodes of the neck in Swedish schoolchildren. Acta Paediatr 1994;83:1092-4
  14. Barton LL, Feigin RD. Childhood cervical lymphadenitis : a reappraisal. J Pediatr 1974;84:846-52 https://doi.org/10.1016/S0022-3476(74)80761-4
  15. Zitelli BJ. Evaluating the child with a neck mass. Contemp Pediatr 1990;7:90-112
  16. Bleyer WA. The impact of childhood cancer on the United States and the world. CA Cancer J Clin 1990;40:355-67 https://doi.org/10.3322/canjclin.40.6.355
  17. Bonilla JA, Healy GB. Management of malignant head and neck tumors in children. Pediatr Clin North Am 1989;36:1443-50
  18. Leung KC, Robson WL. Childhood cervical lymphadenopathy. J Pediatr Health Care 2004;18:3-7
  19. Jereb B, Us-Krasovec M, Jereb M. Thin-needle biopsy of solid tumors in children. Med Pediatr Oncol 1978;4:1354-7
  20. Ramadan HH, Wax MK, Boyd CB. Fine-needle aspiration of head and neck masses in children. Am J Otolaryngol 1997;18:400-4 https://doi.org/10.1016/S0196-0709(97)90061-2
  21. Haque MA, Talukder SI. Evaluation of fine needle aspiration cytology(FNCA) of lymph node in Mymensingh. Mymensingh Med J 2003;12:33-5
  22. Bodenstein L, Altman RP. Cervical lymphadenitis in infants and children. Semin Pediatr Surg 1994;3:134-41
  23. Nahar Saikia U. Image-guided fine-needle aspiration cytology of deep-seated enlarged lymph nodes. Acta Radiol 2002;43:230-4
  24. Fajardo LL, Davis JR, Wiens JL, Trego DC. Mammography guided stereotactic fine-needle aspiration cytology of nonpalpable breast lesions : prospective comparison with surgical biopsy results. Am J Roentgenol 1990;155:977-81 https://doi.org/10.2214/ajr.155.5.2120967
  25. Eltahir A, Jibril JA, Squair J. The accuracy of one-stop diagnosis for 1110 patients presenting to a symptomatic breast clinic. J R Coll Surg Edinb 1999;44:226-30
  26. Pilgrim S, Ravichandran D. Fine needle aspiration cytology as an adjunct to core biopsy in the assessment of symptomatic breast carcinoma. Breast. In press 2005
  27. Wagner LA, Hayden GF. Kawasaki syndrome masquerading as bacterial lymphadenitis. Clin Pediatr 1995;34:185-9 https://doi.org/10.1177/000992289503400403
  28. Caglayan S. Is medical therapy effective for regional lymphadenitis following BCG vaccination? Am J Dis Child 1987;141:1213-4
  29. Goldman KP. Treatment of local complications of BCG vaccination. Tubercle 1985;66:158-9 https://doi.org/10.1016/0041-3879(85)90032-7
  30. Dorfman RF, Berry GJ. Kikuchi's histiocytic necrotizing lymphadenitis : An analysis of 108 cases with emphasis on differential diagnosis. Semin Diagn Pathol 1988;5:329-45
  31. Kikuchi M. Lymphadenitis showing focal reticulum cell hyperplasia with unclear debris and phagocytosis. Nippon Kesueki Gakkai Zasshi 1972;35:379-90
  32. Fujimono Y, Kojima Y. Cervical subacute necrotizing lymphadenitis. Naika 1972;30:920-7
  33. Evans CS, Goldman RL, Klein HZ, Kohout ND. Kikuchi's necrotizing lymphadenitis. West J Med 1985;143:346-8