B-Cell Lymphoma Clinical Presentation

Updated: Sep 25, 2017
  • Author: Mohammad Muhsin Chisti, MD, FACP; Chief Editor: Emmanuel C Besa, MD  more...
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Presentation

History

Lymphadenopathy is the most common manifestation of lymphoma. Symptoms can include fevers, night sweats, weight loss, and fatigue. In addition, symptoms related to mass effect are common. In addition, pruritus has been observed in patients with lymphoma.

The duration of symptoms and the pace of progression should be documented. The possibility that waxing and waning lymphadenopathy may be due to lymphoma should not be discounted. Spontaneous remissions have been documented in some patients with lymphoma. This most commonly occurs in low-grade lymphomas.

Systemic symptoms known to be associated with adverse prognosis include unexplained fevers, night sweats, and weight loss. Organ-specific symptoms, such as shortness of breath, chest pain, cough, abdominal pain and distention, or bone pain, may lead to identification of specific sites of involvement. Careful evaluation for neurologic symptoms is also appropriate because central nervous system (CNS) involvement may occur with aggressive histologies.

A history of concurrent illness, such as diabetes or congestive heart failure, might modify therapeutic decisions. In addition, organ transplantation or HIV may provide diagnostic and prognostic insight in cases of non-Hodgkin lymphoma (NHL).

A family history and a history of prior radiation therapy should be obtained; a history of exposure to other putative risk factors (see Pathophysiology and Etiology) is important as well. Although allogeneic bone marrow transplantation is rarely used in NHL, ascertaining the number of siblings that share both parents with the patient may be useful. Most lymphomas do not have a familial pattern; however, coexistence of multiple breast cancers, ovarian cancer, sarcomas, and lymphomas in a family may suggest an inherited abnormality in tumor suppressor genes.

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Physical Examination

The physical examination of a patient with an advanced high-grade lymphoma may reveal high fever, tachycardia, and respiratory distress. However, the physical examination more typically reveals pallor (suggesting anemia) or purpura, petechiae, or ecchymoses (suggesting thrombocytopenia).

Examination should include palpation of all lymph node–bearing areas as well as assessment of hepatomegaly and splenomegaly. Pharyngeal involvement, a thyroid mass, evidence of pleural effusion, abdominal mass, testicular mass, and cutaneous lesions are examples of findings that might direct further investigations and subsequent therapy. A neurologic examination is appropriate at diagnosis.

Certain associations of involvement between various organ sites are noteworthy. Approximately 25% of patients with involvement of Waldeyer ring have involvement of the gastrointestinal (GI) tract, and the converse is also true. This finding occurs most commonly in mantle cell lymphoma.

Patients with paranasal sinus involvement, testicular involvement, and epidural lymphoma are particularly prone to have meningeal involvement and thus require a diagnostic lumbar puncture. One quarter of patients with bone marrow involvement by large cell lymphoma also have CNS disease. Patients with one testicle involved are likely to relapse in the contralateral testis.

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Complications

Complications of NHL include the following:

  • Lymphomatous meningitis
  • Superior vena cava syndrome
  • Other compression syndromes arising from compression of neighboring structures by bulky lymphadenopathy (eg, bilateral ureteric obstruction leading to obstructive uropathy, subacute intestinal obstruction due to compression of the bowel, pain or paraparesis secondary to compression of the nerve roots)
  • Spinal cord compression either from extradural compression from large masses or secondary to bony compression, especially in the setting of vertebral collapse
  • Pathologic fractures of long bones - May occur secondary to involvement by B-cell lymphoma
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