Summary
Definition
History and exam
Key diagnostic factors
- Síntomas B (fiebre, sudores nocturnos, pérdida de peso)
- fatiga/malestar general
Other diagnostic factors
- linfadenopatía
- esplenomegalia
- hepatomegalia
- disnea
- tos
- molestias abdominales
- cefalea
- cambio del estado mental
- déficits neurológicos focales
- dolor torácico
- dolor óseo, dolor de espalda
- ictericia
- palidez
- púrpura
- lesiones cutáneas
- alteraciones neurológicas en la exploración
- Dolor mamario
- hinchazón o masa en la mama
Risk factors
- >50 años de edad
- sexo masculino
- Virus de Epstein-Barr (VEB)
- virus linfotrópico humano de células T de tipo 1 (HTLV-1)
- virus del herpes humano-8 (virus del herpes asociado al sarcoma de Kaposi)
- Helicobacter pylori
- enfermedad celíaca
- VIH
- virus de la hepatitis C (VHC)
- Síndrome de Sjögren
- síndrome de Wiskott-Aldrich
- ataxia telangiectasia
- uso de fármacos inmunomoduladores
- trasplante de órganos
- Borrelia burgdorferi
- Coxiella burnetii
- Chlamydia psittaci
- Campylobacter jejuni
- artritis reumatoide
- lupus eritematoso sistémico (LES)
- inmunodeficiencia común variable
- síndrome de Chediak-Higashi
- Síndrome de Klinefelter
- pesticidas
- herbicidas fenoxi
- implantes de senos
Diagnostic investigations
1st investigations to order
- hemograma completo (HC) con diferencial
- frotis de sangre periférica
- Perfil metabólico completo (incluidas las pruebas de función hepática [PFH])
- lactato deshidrogenasa (LDH) en suero
- ácido úrico
- biopsia del ganglio linfático
- biopsia (sitios extraganglionares, por ejemplo, cerebro, piel)
- biopsia de médula ósea y aspirado
- inmunohistoquímica
- citometría de flujo
- tomografía por emisión de positrones (TEP) con fluorodesoxiglucosa (FDG)/exploración por TC
Investigations to consider
- biopsia por punción con aguja gruesa
- Biopsia por aspiración con aguja fina (AAF)
- pruebas genéticas
- serología de hepatitis B y C
- prueba de virus de la inmunodeficiencia humana (VIH)
- prueba del virus de Epstein-Barr (VEB)
- pruebas del virus linfotrópico humano de células T (HTLV)
- IRM (cerebro, columna vertebral)
- ecografía (mama, axila)
- punción lumbar
- endoscopía y colonoscopia
- electroforesis de proteínas séricas con inmunofijación
- inmunoglobulinas cuantitativas
- microglobulina beta-2 sérica
- Prueba de Helicobacter pylori
- exploración de adquisición por puerta múltiple (MUGA)
- ecocardiografía
Treatment algorithm
linfomas de células B agresivos
linfomas de células T agresivos
linfomas de células B indolentes
linfomas de células T indolentes
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: B-cell lymphomas [internet publication].Full text
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: T-cell lymphomas [internet publication].Full text
Tilly H, Gomes da Silva M, Vitolo U, et al. Diffuse large B-cell lymphoma (DLBCL): ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015 Sep;26(suppl 5):v116-25.Full text Abstract
Vitolo U, Seymour JF, Martelli M, et al. Extranodal diffuse large B-cell lymphoma (DLBCL) and primary mediastinal B-cell lymphoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016 Sep;27(suppl 5):v91-102.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Linfoma de Hodgkin
- Leucemia linfoblástica aguda (LLA)
- Mononucleosis infecciosa
More DifferentialsGuidelines
- Suspected cancer: recognition and referral
- NCCN clinical practice guidelines in oncology: hematopoietic cell transplantation (HCT)
More GuidelinesPatient information
Non-Hodgkin's lymphoma
Non-Hodgkin lymphoma: questions to ask your doctor
More Patient informationVideos
Demostración animada de venopunción y flebotomía
Punción lumbar diagnóstica en adultos: demostración animada
More videos
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer