Summary
Definition
History and exam
Key diagnostic factors
- night sweats
- weight loss
- fatigue/malaise
- fever
Other diagnostic factors
- lymphadenopathy
- massive splenomegaly in marginal zone lymphoma
- hepatomegaly
- shortness of breath
- cough
- abdominal discomfort
- headache
- change in mental status
- focal neurologic deficits
- chest pain
- bone pain, back pain (bone involvement)
- jaundice
- pallor
- purpura
- skin lesions
- neurologic abnormalities on exam
Risk factors
- age >50 years
- male sex
- Epstein-Barr virus (EBV)
- human T-lymphocytotrophic virus-1 (HTLV-1)
- human herpesvirus-8
- Helicobacter pylori
- celiac disease
- HIV
- hepatitis C virus (HCV)
- Sjogren syndrome
- Wiskott-Aldrich syndrome
- ataxia-telangiectasia
- use of immunomodulatory drugs
- organ transplant
- Borrelia burgdorferi
- Coxiella burnetii
- Chlamydia psittaci
- rheumatoid arthritis
- systemic lupus erythematosus (SLE)
- common variable immunodeficiency
- Chediak-Higashi syndrome
- Klinefelter syndrome
- pesticides
- phenoxyherbicides
- breast implants
Diagnostic investigations
1st investigations to order
- lymph node biopsy
- PET/CT scan
- PET scan
- CBC with differential
- blood smear
- skin biopsy
- bone marrow biopsy
- basic metabolic panel
- liver function tests
- lactate dehydrogenase (LDH)
Investigations to consider
- flow cytometry
- immunohistochemistry
- polymerase chain reaction for tumor markers
- immunoglobulin gene rearrangement studies
- cytogenetics studies with or without fluorescence in situ hybridization (FISH)
- hepatitis B and C serology
- HIV antibody
- lumbar puncture
- colonoscopy
- serum protein electrophoresis with immunofixation
- multiple-gated acquisition scan
- echocardiography
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
Julie E. Chang, MD
Associate Professor
Department of Medicine, Section of Hematology & Oncology
University of Wisconsin School of Medicine and Public Health
Madison
WI
Disclosures
JEC has been paid for time served on advisory boards for MorphoSys, BeiGene, and Genentech. JEC has research funding from Genentech and Celgene.
Acknowledgements
Dr Julie Chang would like to gratefully acknowledge Dr Esther Chan, Dr Chin Hin Ng, Dr Melissa Ooi, Dr Michelle Poon, Dr Boris Kobrinsky, and Dr Kenneth B. Hymes, previous contributors to this topic.
Disclosures
EC, CHN, MO, BK, and KBH declare that they have no competing interests. MP has received sponsorship from Sanofi and Janssen to attend conferences.
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.
Shankaranarayana 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.
Differentials
- Hodgkin lymphoma
- Acute lymphoblastic leukemia
- Infectious mononucleosis
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: T-cell lymphomas
- NCCN clinical practice guidelines in oncology: hematopoietic cell transplantation (HCT)
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