Summary
Definition
History and exam
Key diagnostic factors
- night sweats
- weight loss
- fatigue/malaise
- fever
Other diagnostic factors
- lymphadenopathy
- splenomegaly
- hepatomegaly
- shortness of breath
- cough
- abdominal discomfort
- headache
- change in mental status
- dizziness, ataxia
- chest pain
- bone pain, back pain (bone involvement)
- jaundice
- pallor
- purpura
- skin lesions
- neurological abnormalities on examination
Risk factors
- age >50 years
- male sex
- Epstein-Barr virus (EBV)
- human T-lymphocytotrophic virus-1 (HTLV-1)
- human herpesvirus-8
- Helicobacter pylori
- coeliac disease
- HIV
- hepatitis C virus (HCV)
- Sjogren syndrome
- Wiskott-Aldrich syndrome
- ataxia-telangiectasia
- organ transplant
- Borrelia burgdorferi
- rheumatoid arthritis
- systemic lupus erythematosus (SLE)
- common variable immunodeficiency
- Chediak-Higashi syndrome
- Klinefelter syndrome
- pesticides
- phenoxyherbicides
- breast implants
Diagnostic investigations
1st investigations to order
- FBC with differential
- blood smear
- lymph node biopsy
- skin biopsy
- bone marrow biopsy
- basic metabolic panel
- liver function tests
- lactate dehydrogenase (LDH)
Investigations to consider
- flow cytometry
- immunohistochemistry
- polymerase chain reaction for tumour markers
- immunoglobulin gene rearrangement studies
- cytogenetics studies with or without fluorescence in situ hybridisation (FISH)
- hepatitis B and C serology
- HIV antibody
- lumbar puncture
- colonoscopy
- CT scan
- multiple-gated acquisition scan
- echocardiography
- PET scan
Emerging tests
- gene expression profiling
Treatment algorithm
aggressive B-cell lymphomas
aggressive T-cell lymphomas
indolent B-cell lymphomas
indolent T-cell lymphomas
Contributors
Authors
Esther Chan, MD
Consultant
Department of Haematology-Oncology
National University Cancer Institute
Singapore
Disclosures
EC declares that she has no competing interests.
Chin Hin Ng, MD, MRCP, FRCPath
Consultant
Department of Haematology-Oncology
National University Cancer Institute
Singapore
Disclosures
CHN declares that he has no competing interests.
Melissa Ooi, MB BCh, BAO, MRCP(I), FRCPath, PhD
Consultant
Department of Haematology-Oncology
National University Cancer Institute
Singapore
Disclosures
MO declares that she has no competing interests.
Michelle Poon, MBBS, MRCP, FRCPath
Senior Consultant
Department of Haematology-Oncology
National University Cancer Institute
Singapore
Disclosures
MP has received sponsorship from Sanofi and Janssen to attend conferences.
Acknowledgements
Dr Esther Chan, Dr Chin Hin Ng, Dr Melissa Ooi, and Dr Michelle Poon would like to gratefully acknowledge Dr Boris Kobrinsky and Dr Kenneth B. Hymes, previous contributors to this topic.
Disclosures
BK and KBH declare that they have no competing interests.
Peer reviewers
Leonidas G. Koniaris, MD
Associate Professor Surgery
Department of Cell Biology and Anatomy
University of Miami School of Medicine
Coral Gables
FL
Disclosures
LGK declares that he has no competing interests.
Shankaranarayanan Paneesha, MD, MRCP, FRCPath
Consultant Haematologist
Department of Haematology and Stem Cell Transplantation
Heartlands Hospital
Birmingham
UK
Disclosures
SP declares that he has no competing interests.
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- Hodgkin's lymphoma
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