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Background and objective: Lymphadenopathy is a common medical problem. A lymph node biopsy may be necessary for definitive diagnosis in selected cases. Methods: The study group included a retrospective, hospital-based series of patients who had a cervical lymph node biopsy at the Saudi Aramco Medical Services organization between 1997 and 2008. Results: During the study period, there were a total of 452 cervical lymph node biopsies. Biopsies were performed on 122 (27%) children ≤18 years and 81 (18%) patients >60 years. The most common histopathological diagnosis was reactive disease (52.2%, n = 236), which was followed by granulomatous disease (15.5%, n = 70). We detected carcinoma in 14.6% of the patients (n = 66), Hodgkin's lymphoma in 8.8% (n = 40) and non-Hodgkin's disease in 8.8% (n = 40). Malignancy was more common in adults than children (19.5% vs. 1.6%, respectively and reactive disease was more common in children than adults (65.3% vs. 47.3%, respectively). Metastatic disease was more likely in the older age group (17.7% vs. 0%), Hodgkin's disease was found in 12.5% of the adolescents, and non-Hodgkin's disease was present in 10.3% of the adults and elderly. Conclusion: The most common histopathological findings for cervical lymph node biopsies in eastern Saudi Arabia were reactive disease and granulomatous disease. Keywords: Tuberculosis, Mycobacterium tuberculosis, TB, Lymphadenopathy