Non-Hodgkin Lymphoma (NHL) Differential Diagnoses

Updated: Jun 22, 2023
  • Author: Sanjay Vinjamaram, MD, MPH; Chief Editor: Emmanuel C Besa, MD  more...
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Diagnostic Considerations

A significant number of medical disorders can produce local or generalized lymph node enlargement. Thus, the diagnosis of non-Hodgkin lymphoma (NHL) relies on pathological confirmation following appropriate tissue biopsy.

The following are some of the conditions that can result in clinical manifestations similar to those observed in lymphoma patients:

  • Solid tumor malignancies: metastatic disease to lymph nodes secondary to carcinoma, melanoma, or sarcoma

  • Other hematologic malignancies or lymphoproliferative disorders: granulocytic sarcoma, multicentric Castleman disease

  • Benign lymph node infiltration or reactive follicular hyperplasia secondary to infection (eg, tuberculosis; other bacterial, fungal, and, rarely, viral infections), and collagen-vascular diseases

  • Hodgkin lymphoma, which requires a different treatment strategy than NHL

If the diagnosis of NHL is doubtful, acquire a second or third opinion from an expert hematopathologist before instituting therapy. Flow cytometry and cytogenetics should also be performed and can be especially helpful in difficult situations.

Differential Diagnoses