Lymph Node in Neck - Benign or Not

In older kids, masses in the neck sort of fall into two or three categories; there are kids who have lymph nodes that swell up, what sometimes people call glands. Now the thing is, every person in the world has lymph nodes all over their body. It is where the immune cells, the cells that fight infection hang out in your body. It is where the immune cells are collected until they are needed. Children who have never been exposed to various viruses, catch a cold from their friends, catch a cold in the world, get infections and what happens is their immune system responds very, very dramatically and those lymph nodes get large and swell up. So it is very common for a small child who gets a sore throat to have big lymph nodes in their neck or if they get an ear ache, that big lymph node is in the back of their neck or if they have a cold, or if they have a tooth ache, there are countless reasons to have lymph nodes swell up. the problem for pediatricians and the problem for a pediatric surgeon is that there are also serious diseases that can involve the lymph nodes. There is a kind of tumor of the immune system called lymphoma which may present as a swollen lymph node. And so parents and pediatricians become concerned when they see a lymph node that is in a patient’s neck that they had not noticed before. And the question arises, well should you biopsy it? Should you do an operation that take the lymph node out to allow pediatric pathologists to look at it and decide if it is lymphoma or not? Well the answer is that there is no absolute answer. We try to use common sense. If I operated on every child who had a palpable lymph node—a lymph node that I could feel in their neck, I would be a very wealthy man because I could operate on every single child. Every child in the world has lymph nodes in their neck that you can feel. So what we do is we try to ascertain how long the lymph node has been there. If it was there since the child had an earache two weeks earlier, it is almost certainly related to the earache. If the child is teething, it is probably related to their gums. If a child had a sore throat, it is probably related to this sore throat. So if a lymph node is palpable and appears fairly suddenly, that is usually a sign that it is related to it.
So if a lymph node gets large suddenly, grows quickly, it is almost always related to an acute event, an infection and so a lymph node that just appears suddenly and is very large, we usually would wait a few weeks and see if it starts to shrink. The actual size of the lymph node matters as well. If it is a little lymph node or if there are multiple lymph nodes clustered together that are fairly small and soft, we usually will wait and see what happens.
If the lymph node has been large and then gets smaller and then enlarges again and then gets smaller again, it is also more likely that it is just a reactive lymph node. A lymph node where the immune system is reacting to infection or inflammation—so those are the ones that we leave alone; it sounds as though I am joking, but what I say to parents many times is that anything that gets big and then gets smaller again is very unlikely to be something that is bad.
If there is a lymph node that is rubbery in texture, and is slowly growing and persists when the child has no other signs or symptoms of problems, those are the ones that we find more suspicious and those are the ones where we would be more like to biopsy it, to schedule an operation to make a little incision over the lymph node and take it out.