Professional Documents
Culture Documents
Pediatric Non-Hodgkin
Lymphoma Clinical Presentation
Updated: Feb 06, 2017
Author: J Martin Johnston, MD; Chief Editor: Max J Coppes, MD, PhD, MBA more...
PRESENTATION
History
The presentation of patients with non-Hodgkin lymphoma is acute or subacute, in contrast to the
indolent course that characterizes most lymphomas in adults.
The duration of symptoms before diagnosis is generally 1 month or less, with specific complaints
varying according to the predominant sites of involvement.
Bone marrow involvement in non-Hodgkin lymphoma may cause generalized or migratory bone
pain, but clinically significant cytopenias are uncommon, with their presence suggesting a
diagnosis of acute leukemia.
Patients with supradiaphragmatic disease (eg, lymphoblastic lymphoma) often report having a
nonproductive cough, dyspnea, chest pain, and dysphagia.
Abdominal tumors (usually small noncleaved cell lymphoma [SNCCL] or B-cell large cell lymphoma
[LCL]) are associated with abdominal pain, constipation, masses, or ascites. An acute abdomen
occasionally is observed and may be mistaken for appendicitis. Rare primary non-Hodgkin
lymphoma of the pancreas presents with the clinical picture of pancreatitis. [44]
Patients with anaplastic LCLs sometimes present with painful skin lesions, bone lesions, peripheral
lymphadenopathy, and hepatosplenomegaly. [45, 46] The painful skin lesions may regress
spontaneously. A finding less common than these is testicular, lung, or muscle involvement.
https://emedicine.medscape.com/article/987540-clinical 1/3
5/28/2018 Pediatric Non-Hodgkin Lymphoma Clinical Presentation: History, Physical Examination
Anaplastic LCLs may also result in an apparent cytokine storm, with fevers, vascular leakage, and
pancytopenia.
Other
Physical Examination
Patients with non-Hodgkin lymphoma generally appear mildly to moderately ill. They occasionally
have a low-grade fever. Patients may present with pallor, respiratory distress, pain, and discomfort.
A jaw or orbital mass is present in as many as 10% of patients in industrialized countries, but this
finding is particularly common in African patients with endemic Burkitt lymphoma.
In patients with superior vena cava syndrome, distended neck veins and plethora may be
observed
Painful skin lesions suggest an anaplastic large cell lymphoma (LCL); the less common forms
of cutaneous lymphoma (T-cell, blastic plasmacytoid dendritic) are typically nontender
Focal pain or swelling in the extremity may be present in patients with primary bone
lymphoma.
Nasopharyngeal mass
Parotid enlargement
Nephromegaly
Testicular enlargement
https://emedicine.medscape.com/article/987540-clinical 2/3
5/28/2018 Pediatric Non-Hodgkin Lymphoma Clinical Presentation: History, Physical Examination
Differential Diagnoses
https://emedicine.medscape.com/article/987540-clinical 3/3