Last reviewed: June 2018
Last updated: March  2018

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
  • dizziness, ataxia
  • chest pain
  • bone pain, back pain (bone involvement)
  • jaundice
  • pallor
  • purpura
  • skin lesions
  • neurologic abnormalities on exam

Risk factors

  • age >50 years
  • male sex
  • immunocompromised host
  • Epstein-Barr virus (EBV)
  • human T-lymphocytotrophic virus-1 (HTLV-1)
  • human herpesvirus-8
  • Helicobacter pylori
  • celiac disease
  • HIV
  • organ transplant
  • hepatitis C virus (HCV)
  • Borrelia burgdorferi
  • Sjogren syndrome
  • Rheumatoid arthritis
  • systemic lupus erythematosus (SLE)
  • common variable immunodeficiency
  • Wiskott-Aldrich syndrome
  • ataxia-telangiectasia
  • Chediak-Higashi syndrome
  • Klinefelter syndrome
  • pesticides
  • phenoxyherbicides
  • breast implants

Diagnostic investigations

1st investigations to order

  • CBC with differential
  • blood smear
  • lymph node biopsy
  • skin biopsy
  • bone marrow biopsy
  • basic metabolic panel
  • liver function tests
  • LDH
Full details

Investigations to consider

  • flow cytometry
  • immunohistochemistry
  • PCR 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
  • CT scan
  • multiple-gated acquisition scan
  • echocardiography
  • PET scan
Full details

Emerging tests

  • gene expression profiling
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Consultant

Department of Haematology-Oncology

National University Cancer Institute

Singapore

Disclosures

EC declares that she has no competing interests.

Consultant

Department of Haematology-Oncology

National University Cancer Institute

Singapore

Disclosures

CHN declares that he has no competing interests.

Consultant

Department of Haematology-Oncology

National University Cancer Institute

Singapore

Disclosures

MO declares that she has no competing interests.

Senior Consultant

Department of Haematology-Oncology

National University Cancer Institute

Singapore

Disclosures

None declared.

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. BK and KBH declare that they have no competing interests.

Peer reviewers VIEW ALL

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.

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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