Clinical Presentation
Patients presented with slow-growing lymphadenopathy preceding biopsy
for durations ranging from one month to “several years” on history;
this was not often specified in the EMR. The majority of cases were
diagnosed after initial presentation to an otolaryngologist or general
surgeon resulted in biopsy, with only 9 patients (16%) seen by a
pediatric hematology/oncology (PHO) specialist prior to biopsy. One
patient presented with a two-week history of fevers. No patients
reported weight loss or night sweats. Of the 57 patients, 38 underwent
radiologic imaging prior to LN biopsy; two of the three patients who
received PET scans had concurrent diagnoses of lymphoma (Fig. 1).
Laboratory evaluation of patients with PTGC was variable. Of the 57
patients, 28 had no perioperative blood tests sent at all, and 3
additional patients had blood tests that were reportedly normal per
comment in the chart but not specified in the EMR. The most frequently
ordered labs were complete blood counts with differentials (CBC),
complete metabolic panels (CMP), erythrocyte sedimentation rates (ESR),
lactate dehydrogenase (LDH), and uric acid (Fig. 2). Three patients had
leukopenia noted on their CBC and one patient had leukocytosis. One
patient had notable anemia with a hemoglobin of 7.2 g/dL, but also had
sickle cell disease, for which she was followed by PHO. No patients had
thrombocytopenia at time of diagnosis. CMPs collected were all within
normal range except for four patients who had mild elevations in total
protein. One patient had an elevated ESR, one patient had an elevated
LDH, and no patients had elevated uric acid levels based on our
laboratory’s normal values.