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, EBV [infectious mononucleosis], cytomegalovirus, HIV)
Parasites (eg, toxoplasmosis)

Nasal granulomatous diseases

These include the following:

Wegener granulomatosis
Lymphomatoid granulomatosis
Infections (eg, leishmaniasis, syphilis)

Mediastinal presentations

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

Otolaryngologic Manifestations of Granulomatosis With Polyangiitis
Skin Cancer: Squamous Cell Carcinoma

Workup

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Media Gallery

CT scan of a patient with a natural killer (NK)/T-cell lymphoma of the right nasal cavity and maxillary sinus.
CT scan 6 months after treatment with 4 cycles of DA-EPOCH (ie, infused etoposide, doxorubicin, and vincristine with bolus cyclophosphamide and prednisone).
CT scan of a patient with a recurrence of stage I-AE angiocentric lymphoma of the left maxillary sinus, treated 7 years earlier with 4 cycles of ProMACE-MOPP (ie, prednisone, methotrexate, Adriamycin, cyclophosphamide, etoposide–mechlorethamine [nitrogen mustard], vincristine, procarbazine, and prednisone) and 3960 cGy of radiation.
CT scan 2 years after salvage therapy.
Fiberoptic nasal examination of a patient with natural killer (NK)/T-cell lymphoma of the right nasal cavity and maxillary sinus.

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Author

Jordan W Rawl, MD Fellow in Head and Neck Oncological Surgery and Microvascular Reconstruction, Nebraska Methodist Estabrook Cancer Center, Creighton University School of Medicine

Jordan W Rawl, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Nothing to disclose.

Coauthor(s)

Aru Panwar, MD Head and Neck Surgical Oncologist, Methodist Estabrook Cancer Center, Nebraska Methodist Hospital; Associate Professor, Department of Surgery, Creighton University School of Medicine

Aru Panwar, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Karen H Calhoun, MD, FACS, FAAOA Professor, Department of Otolaryngology-Head and Neck Surgery, Ohio State University College of Medicine

Karen H Calhoun, MD, FACS, FAAOA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Head and Neck Society, Association for Research in Otolaryngology, Southern Medical Association, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Rhinologic Society, Society of University Otolaryngologists-Head and Neck Surgeons, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan; Ryte; Neosoma; MI10<br/>Received income in an amount equal to or greater than $250 from: Neosoma; Cyberionix (CYBX)<br/>Received ownership interest from Cerescan for consulting for: Neosoma, MI10.

Additional Contributors

Daniel J Kelley, MD Consulting Staff, Eastern Shore ENT and Allergy Associates and Peninsula Regional Medical Center

Daniel J Kelley, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, The Triological Society

Disclosure: Nothing to disclose.

Erik Kass, MD Chief, Department of Clinical Otolaryngology, Associates in Otolaryngology of Northern Virginia

Erik Kass, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Association for Cancer Research, American Rhinologic Society

Disclosure: Nothing to disclose.

Wyndham Wilson, MD, PhD Senior Investigator, Division of Clinical Sciences, National Institutes of Health National Cancer Institute

Disclosure: Nothing to disclose.

Kieron M Dunleavy, MD Professor of Medicine, Director of Lymphoma Program, Co-Director of Microbial Oncology Program, Division of Hematology and Oncology, GWU Cancer Center

Kieron M Dunleavy, MD is a member of the following medical societies: American Society of Hematology

Disclosure: Nothing to disclose.