Which physical findings are characteristic of lymphoblastic lymphoma?

Updated: Sep 10, 2019
  • Author: Joseph M Tuscano, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Answer

On physical examination, mediastinal adenopathy in a young adult is the predominant finding (60-70% of patients with lymphoblastic lymphoma, likely reflecting the thymic origin of most of these lymphomas and, therefore, is an uncommon feature of B-cell lymphoblastic lymphoma). Pleural, pericardial, and superior vena cava syndrome are also frequent presenting features. Peripheral lymph node involvement is present in 60-80% of patients at diagnosis.

Lymphoblastic lymphoma has a predilection for the bone marrow, with a reported incidence at diagnosis of 21% as well as a reported incidence of 5-10% for the central nervous system (CNS). CNS involvement is more frequent at relapse, particularly in the absence of adequate CNS prophylaxis, with one series reporting 31% CNS involvement at relapse. [11]

Peripheral blood involvement is also common, but the true incidence is confounded by the previous inconsistencies in the distinction between lymphoblastic lymphoma and acute lymphoblastic leukemia (ALL). Other more rare sites of involvement include the liver, spleen, and testes. Skin and oropharyngeal involvement is more common in children with B-cell lymphoblastic lymphoma. Signs of involvement include the following:

  • Painless lymphadenopathy

  • Pallor

  • Petechiae

  • Ecchymoses

  • Splenomegaly

  • Neurologic deficits

  • Gonadal masses


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