Diffuse Large B-Cell Lymphoma (DLBCL) Clinical Presentation

Updated: Aug 20, 2020
  • Author: Shipra Gandhi, MBBS; Chief Editor: Emmanuel C Besa, MD  more...
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Presentation

History

The clinical manifestations of  diffuse large B-cell lymphoma (DLBCL) are diverse and depend on the site of disease involvement. These tumors have a rapid growth rate and present as masses, causing symptoms when they infiltrate tissues or obstruct organs. Although lymphadenopathy may initially be painless, pain in an enlarged lymph node or affected organ may be noted if the lymphomatous mass enlarges rapidly.

As with other types of non-Hodgkin lymphoma (NHL), DLBCL can manifest with B symptoms: fever higher than 38°C, night sweats, and/or weight loss of more than 10% of body weight in the preceding 6 months. Generalized pruritus may also be present.

Other signs and symptoms can include the following:

  • Anorexia
  • Pedal edema - Caused by extensive pelvic lymphadenopathy
  • Fatigue
  • Chest discomfort or shortness of breath - Caused by mediastinal lymphadenopathy

Medical history should include inquiries about the following:

  • Duration/intensity of symptoms, with special attention to B symptoms
  • Neurological or gastrointestinal manifestations
  • History of environmental and/or infectious pathogens (eg, HIV, hepatitis B or C virus)
  • Exposure to certain viral organisms, which may affect treatment selection or outcome
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Physical Examination

On physical examination, keep in mind that diffuse large B-cell lymphoma (DLBCL) appears most frequently in lymphoreticuloendothelial tissues, which include the lymph nodes, spleen, liver, and bone marrow. However, any extranodal site may be primarily or secondarily involved, including the central nervous system (CNS), lungs, gastrointestinal tract, genitourinary tract, and bones.

Involvement of sanctuary sites, including the CNS and testicles, occurs more commonly with the following disorders:

  • Burkitt and non-Burkitt lymphoma
  • HIV-associated lymphoma
  • Human T-cell leukemia virus (HTLV) type 1–associated lymphoma
  • Primary CNS lymphoma
  • Primary testicular diffuse large cell lymphoma

The following are common findings on physical examination in patients with DLBCL:

  • Lymphadenopathy - Ie, cervical, axillary, and inguinal
  • Low-grade fever
  • Pedal edema - Resulting from extensive pelvic lymphadenopathy

The clinical spectrum observed in lymphoma patients is diverse and is influenced by the subtype of lymphoma and its anatomical relationship with other organs and/or systems. Symptoms vary from painless lymph node enlargement to rapidly progressive lymphadenopathy and extranodal disease associated with end-organ damage (eg, superimposed infection, bone marrow, renal, hepatic or cardiac failure).

The clinical characteristics observed in lymphoma patients can be grouped in the following categories:

  • Structural dysfunction of anatomy such as, swelling, pain, organ obstruction, ulceration, or bleeding
  • Disruption of normal organ function as the result of extranodal involvement of liver, CNS, or kidney
  • Remote dysfunction of organ function (ie, paraneoplastic syndrome) such as hypercalcemia and B-symptoms (ie, night sweats, fever, itching, weight loss)

A complete physical examination should include evaluation of the following:

  • All lymph node chains
  • Cardiopulmonary system
  • Liver and spleen
  • Pelvis
  • Breasts
  • Testicles
  • Skin
  • Neurological aspects, to detect subtle signs of early CNS involvement or cord compression
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