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Table of Contents
Year : 2013  |  Volume : 15  |  Issue : 1  |  Page : 12-14

Lymphoma and cervical lymphadenopathya

Assistant Professor, Department of Otorhinolaryngology, King Abdulaziz University, Jeddah, Saudi Arabia

Date of Web Publication2-Jan-2020

Correspondence Address:
Khalid B Al Ghamdi
Department of Otorhinolaryngology, King Abdulaziz University, Jeddah, Saudi Arabia, Jeddah 21789, Saudi Arabia
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1319-8491.274642

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Introduction: Cervical lymphadenopathy is a common presentation with diverse etiologies. Lymphoma with all its subtypes is considered to be one of the common pathologies that cause lymphadenopathy especially in the neck.Lymphoma is one of the commonest malignancies all over the globe., and is considered as one of the second commonest malignancy in Saudi Arabia.
Aim: To report the incidence of lymphoma in cervical lymphadenopathy at a single institution (King Abdulaziz University Hospital, Jeddah) over a 6 years period (2006 – 2011).
Design: A retrospective study was conducted. Approval from the ethic committee for research was obtained. Due to the diversity of different software for the data base, all the following nomenclatures were considered potential cases: cervical lymph node biopsy, lymphadenopathy, lymph node biopsy, neck node biopsy, neck dissection, true cut neck biopsy and lymphadenectomy.
Results: There were 271 cases of cervical lymph node biopsies, 86 of which were diagnosed as lymphoma.
Conclusion: This incidence showed that lymphoma should be on top of the differential diagnosis list for both genders and cross all age groups.

Keywords: lymphadenopathy, lymph node biopsy, Hodgkin’s lymphoma, Non-Hodgkin’s lymphoma

How to cite this article:
Al Ghamdi KB. Lymphoma and cervical lymphadenopathya. Saudi J Otorhinolaryngol Head Neck Surg 2013;15:12-4

How to cite this URL:
Al Ghamdi KB. Lymphoma and cervical lymphadenopathya. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2013 [cited 2023 Mar 20];15:12-4. Available from: https://www.sjohns.org/text.asp?2013/15/1/12/274642

  Introduction Top

Cervical lymphadenopathy is a fairly common presentation with a wide spectrum of underlying causes. It presents a challenge to the primary treating physician and surgeon. Frequently, an excisional biopsy is required to establish a diagnosis as malignancy exists among all age groups.

Lymphoma is one of the commonest soft tissue malignancies in all age groups and requires an excisional biopsy of the affected lymph node (s) to confirm the diagnosis and stage the disease and for subtyping. It is considered as one of the second commonest malignancy in Saudi Arabia (of all ages) for both Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL) 11.6%. Lymphoma is the second most common tumor in males (8.7% NHL and 4.1% HL), the third most malignancy in females (6.6% NHL and 2.8% HL) and the second most common tumor in childhood (9.8% NHL and 8.8% HL) according to the National Tumour Registery Data. Generally, lymphoma is classified as Hodgkin’s (HL) disease (first type to discover) and non-Hodgkin’s lymphoma (NHL).

NHL is the commonest and multiple subtypes for each group have been identified with distinct cell biology, presentation, natural history and treatment modality. Hodgkin’s lymphoma has bimodal incidence; age 15-24 years and again above 60 years. There are many classifications of lymphoma such as the Working Formulation (WF), the National Cancer Institute Working Formulation (NCIWF), the Revised European-American Lymphoma classification (REAL) and others.

It is the intension of this article to report on the incidence of lymphoma among cases undergoing open excisional biopsy and compare it with local and international reports of cervical lymph nodes at King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

  Materials and Method: Top

A retrospective electronic chart review of all patients who were admitted to the operating suites for lymph node biopsy.

Due to the diversity of operating surgeons, the surgical teams and booking privileges, we collected all data of all patients undergoing the following procedures; cervical lymph node biopsy, lymph node biopsy, neck node biopsy, lymphadenectomy and neck dissection. Only cases with unexplained cervical lymphadenopathy lasting more than 4 weeks and not responding to antibiotics and observation were enrolled in our sample.

Due to the diversity of surgical cases and surgeons, less than 40% had radiologic invistagations done and mainly in the form of U.S. of the neck in addition to routine blood work (CBC, blood grouping, urea and electrolytes and occasionally liver function tests). All cases undergone open neck biopsy to establish a diagnosis.

  Results Top

There were 271 cases of cervical lymph node biopsies with 86 ( 31.7%) documented cases of lymphoma.

Age Ranges 3-93 years with mean age 35. There were 46 males and 40 females. Of the 81 patients 45 (52.3%) were Saudis and 41 (47.67) non-Saudis.

There were 5 children (5.8%):

2 Burkitt’s lymphoma.

2 Hodgkin’s lymphoma.

1 Non-Hodgkin’s lymphoma.

The patients were diagnosed as either Hodgkin’s lymphoma (HL) or non-Hodgkin’s lymphoma (NHL) with the different sub-groups in each group.

Hodgkin’s lymphoma 44 cases ( 51.6%):

Females = 24

Males = 20

Saudi females 13 ( 29.5%)

Non-Hodgkin’s lymphoma 42 cases ( 48.83%)

Males = 24 cases

Females = 18 cases

Saudi males 14 cases = 33.3%

[Table 1] & [Table 2] summarize the cases.
Table 1: Cases among Saudi patients 45 = 52.3%

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Table 2: Cases among Non Saudi patients 41 = 47.67%

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  Discussion Top

Lymphoma represent 2 -3% of all types of head & neck neoplasm [1]. NHL is the third most common malignant tumor in Saudi Arabia (7.6%) and the eighth most common malignant tumor for HL 3.5% (2 & 3). Among non-Saudis, it ranks the third for adults [2],[3]. For children; it comes in second place for both sexes when combined only to be exceeded by leukemias [2],[3].

Not uncommonly, lymphoma with all subtypes present with cervical lymphadenopathy as the head and neck area is the third most common site of involvement [4]. Thomas et al in their review of 22 cases of pediatric NHL noticed that 45.5% of all cases presented with cervical lymphadenopathy [5] while Alsohaibani reported an incidence of 36% of 1,250 cases of cervical lymph node biopsies done over a period of 12 years at King Fahad University Hospital, [6].

At Aramco Medical Center, there were 80 cases of lymphoma out of 452 cases of cervical lymph node biopsies, with equal incidence of NHL=HL 40 cases for each type with NHL having the higher incidence in adolescent patients [7].

In Asir region, an incidence of 13% of lymphoma was noted in a group of 324 lymph node biopsies from different sites of the patients including the neck [8]. Hanif et al reported an incidence of 14.6% (132) of lymphoma in a collection of 898 lymph node biopsy in the pediatric age group, [9] while others reported 37.9% of lymphoma in adult cases [10]. In other countries, the incidence of lymphoma in cervical lymph node biopsies ranged from 14.2 - 26.1% with higher incidence of non-Hodgkin’s lymphoma than HL [11],[12].

The diagnosis of lymphoma by core needle aspiration under Ultrasound guidance has a success of 89.7% in sub-diagnosing classifying lymphoma and is promising in reducing the need for excisional biopsy in the operating suite [13],[14].

Several risk factors mandates biopsy of the lymph node (s) for proper diagnosis including a duration of more than 4 weeks, a size of more 3cm, [14],[15],[16] advanced age and on US or CT scan ill-defined or heterogeneous enhancement of lymph node [17]. Recently, high levels of serum soluble interleukin-2 receptors (SIL-2r) or lactate dehydrogenase have been added to the risk factor. [18]. Because the biopsies were done in a teaching institution there were good number of teaching cases of non-Saudi origin, the incidence in our series is one of the highest in addition to the growth rate of 3.2 - 2.5 % among Saudi and non-Saudi patients [3].

  Conclusion Top

Lymphoma with its wide subtypes is a fairly common tumor across all age groups presenting as cervical lymphadenopathy. It should be thought of as a potential cause for unexplained cervical adenopathy. The incidence varies from one locality to the other as well as among the different institutions within the same region. In our series it formed more than 31% of all lymph node biopsy results.

  References Top

Mediros LJ, Wahead A. Special tumors of the head and neck region. Histopathology. 2002;41 (Supp1.2);473-93.  Back to cited text no. 1
Cancer incidence report by Saudi Cancer Registry 2000.  Back to cited text no. 2
Cancer incidence report by Saudi Cancer Registry 2008.  Back to cited text no. 3
Dubey SP, Sengupra SK, Kaleh LK, Morewaya JJ, Adult head and neck lymphoma in Papua New Guinea; A retrospective study of 70 cases. ANZ J Surg. 1999;69 (11): 778-8.  Back to cited text no. 4
Thomas OA, Abdebal MA, Ayoub DA. Childhood lymphoma I Saudi Arabia: Experience at King Khalid National Guard Hospital. East Afr Med J. 1996 June; 73 (6) 343-5.  Back to cited text no. 5
AlSohaibani MO. Cervical lymphadenopathy in the eastern province of Saudi Arabia. East Afr Med J. 1996 Aug.; 73 (8): 533 - 7.  Back to cited text no. 6
Al-Tawfiq JA, Raslan W. The analysis of pathological findings of cervical lymph node biopsies in eastern Saudi Arabia. J Infect Public Health. 2012 Apr; 5 (2): 140-4.  Back to cited text no. 7
Morad N, Malatani T, Khan AR, Hussain N. Peripheral lymphadenopathy as a primary presenting sign: A study of 324 cases from Asir region. Ann Saudi Med. 1992 Jan; 12(1): 72-5.  Back to cited text no. 8
Hanif G, Ali SI, Shahid A, Rehman F, Mirza U. Role of biopsy in pediatric lymphadenopathy. Saudi Med J. 2009 Jun; 30(6): 798-802.  Back to cited text no. 9
Abbas AA, Bamgboye AE, Afzal M, Rahmatullah RA. Lypmhadenopathy in adults. A clinicpathological analysis. Saudi Med J. 2002 Mar; 23 (3): 282-6.  Back to cited text no. 10
Anunobi CC, Banjo AA, Abdulkareem FB, Daramola AO, Abudu EK. Review of the histopathologic patterns of superficial lymph node disease in Lagos (1991 - 2004). Niger Postgrad Med J. 2008 Dec; 15 (4): 243-6.  Back to cited text no. 11
Olu-Eddo An, Omoti CE. Diagnostic evaluation of primary-cervical adenopathies in a developing country. Pan Afr Med J. 2011; 10:52 [pub Med]  Back to cited text no. 12
Hung PC, Liu CY, Chung WY, Shih LY, Wan YL. Ultrasound guided core needle biopsy of cervical lymphadenopathy in patients with lymphoma: The clinical efficacy and factors associated with unsuccessful diagnosis. Ultrasound Med Biol. 2012 Sept; 36 (9): 1431 - 6.  Back to cited text no. 13
Burke C, Thomas R, Ingles C, Baldwin A, Ramesar K, Grace R, Howlett DC.Utrasound-guided core biopsy in the diagnosis of lymphoma of the head and neak. A 9 year experience. Br J Radiol. 2011 Aug; 84 (1004): 727-32.  Back to cited text no. 14
Oquz A, Karadeniz C, Temel EA, Citak EC, OKU FV. Evaluation of peripheral lymphadenopathy in children. Pediatr Haematolo Oncol. 2006 Oct-Nov; 23 (7): 549-61.  Back to cited text no. 15
Yaris N, Cakir M, Sozen E, Cobaneglu U. Analysis of children with peripheral lymphadenopathy. Clin pediatr. 2006 Jul; 45 (6): 544-9.  Back to cited text no. 16
Choi JW, Kim SS, Kim EY, Heran M. Peripheral T-cell lymphoma in the neck: CT findings of lymph node involvement. Am J Neuroradiol. 2006 May; 27 (5): 1079 - 82.  Back to cited text no. 17
Massumoto F, Irohs, Ohba S, Yokoi H, Furukana M, Ikeda K. Biopsy of cervical lymph node. Auris Nasus Larynx. 2009 Feb; 36 (1): 71-4.  Back to cited text no. 18


  [Table 1], [Table 2]


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