Which physical findings are characteristic of diffuse large cell lymphoma?

Updated: Jun 12, 2019
  • Author: Shipra Gandhi, MBBS; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

On physical examination, keep in mind that diffuse large cell lymphomas appear most frequently in lymphoreticuloendothelial tissues, which include the lymph nodes, spleen, liver, and bone marrow. However, any extranodal site may be primarily or secondarily involved, including the central nervous system (CNS), lungs, gastrointestinal tract, genitourinary tract, and bones.

Involvement of sanctuary sites, including the CNS and testicles, is more frequently associated with Burkitt and non-Burkitt lymphoma, HIV-associated lymphoma, human T-cell leukemia virus (HTLV) type 1–associated lymphoma, primary CNS lymphoma, and primary testicular diffuse large cell lymphoma.

The following are common findings on physical examination:

  • Lymphadenopathy - Ie, cervical, axillary, and inguinal

  • Low-grade fever

  • Pedal edema - Resulting from extensive pelvic lymphadenopathy

The clinical spectrum observed in lymphoma patients is diverse and is influenced by the subtype of lymphoma its anatomical relationship with other organs and/or systems. Symptoms vary from painless lymph-node enlargement to rapidly progressive lymphadenopathy and extranodal disease associated with end-organ damage (eg, superimposed infection, bone marrow, renal, hepatic or cardiac failure).

The clinical characteristics observed in lymphoma patients can be grouped in the following categories:

  • Structural dysfunction of anatomy such as, swelling, pain, organ obstruction, ulceration, or bleeding

  • Disruption of normal organ function as the result of extranodal involvement of liver, CNS, or kidney

  • Remote dysfunction of organ function (ie, paraneoplastic syndrome) such as hypercalcemia and B-symptoms (ie, night sweats, fever, itching, weight loss)


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