AIDS-Related Lymphomas Clinical Presentation

Updated: Dec 01, 2015
  • Author: Muhammad A Mir, MD, FACP; Chief Editor: Emmanuel C Besa, MD  more...
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Presentation

History

The presenting symptoms and signs of AIDS-related lymphomas (ARLs) depend on the site of involvement and the stage of the disease, which can be very variable. With systemic NHL, patients may complain of feeling a lump in the body or may present with bloating, early satiety, or abdominal pain/fullness due to enlargement of the spleen. Lymphoma may involve the lungs, bone marrow, gastrointestinal tract, and liver, and the involvement may be asymptomatic or may cause organ-specific complaints like pain in right upper quadrant and jaundice. [63]

As such, no pathognomonic features are typically found in AIDS-related lymphomas (ARLs). The majority of patients have constitutional ("B") symptoms at the time of presentation. B symptoms include fever, weight loss greater than 10%, and night sweats. [63]

With PCNSL, patients may present with headache, blurred vision, muscular weakness, sensory deficits, personality changes, depression, apathy, confusion, memory impairment, and cranial neuropathies. These findings may also occur with leptomeningeal involvement. [64]

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Physical

As part of the physical examination in patients with AIDS-related lymphomas (ARLs), attention should be focused on node-bearing areas, including Waldeyer's ring, cervical, occipital, supraclavicular, epitrochlear, axillary and inguinal lymph nodes. Clinical examination should also focus on signs of hepatomegaly and splenomegaly, as well as signs of anemia, including pallor.

Assessment of performance status (ECOG/Karnofsky) is important, as it is useful in formulating the management plan.

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Causes

The etiology of NHL is largely unknown; however, several factors play an important role. These include infections with viruses, namely, EBV infection, HHV-8 infection, and, importantly, B-cell stimulation and immunodeficiency. The interplay of these factors has been discussed above (see Pathophysiology).

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