Lymphomas of the Head and Neck Differential Diagnoses

Updated: May 28, 2019
  • Author: Kieron M Dunleavy, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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DDx

Diagnostic Considerations

The differential diagnosis of lymphadenopathy; extranodal masses in the salivary glands; retro-orbital, thyroid and oral-pharyngeal masses or lesions encompass a wide range of benign and malignant processes other than lymphoma. Reactive lymphoid processes, which may appear as pseudolymphomas, may be difficult to distinguish from lymphoma. Indeed, clonal expansion of benign B or T-cells may occur in some reactive conditions. Adequate biopsy is essential for proper diagnosis, but pathologic interpretation must be considered in light of the patient's medical presentation and the biology of the lymphoma subtype.

Differentiation from lymphomas requires the use of clinical features, histology, immunophenotyping, and gene rearrangement studies for monoclonal population detection. Common differential diagnoses to be considered are listed below.

Other neoplasms

These include the following:

  • Squamous cell carcinoma

  • Nasopharyngeal carcinoma

  • Thyroid carcinoma

Generalized lymphadenopathy from infectious etiologies

These include the following:

  • Bacteria

  • Viruses (eg, Epstein-Barr virus [infectious mononucleosis], cytomegalovirus, HIV)

  • Parasites (eg, toxoplasmosis)

Nasal granulomatous disease

These include the following:

  • Wegener granulomatosis

  • Lymphomatoid granulomatosis

  • Infections (eg, leishmaniasis, syphilis)

Mediastinal presentation

These include the following:

  • Infections (eg, histoplasmosis, tuberculosis)

  • Sarcoidosis

  • Other neoplasms

Benign lymphoid hyperplasias

These include the following:

  • B-cell predominant - Cutaneous lymphoid hyperplasia (CLH), angiolymphoid hyperplasia with eosinophilia, Kimura disease, and Castleman disease

  • T-cell predominant - T-cell CLH, lymphomatoid contact dermatitis, and lymphomatoid drug eruption

Differential Diagnoses