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.