Case history #1
A 55-year-old male farmer presents with worsening shortness of breath, night sweats, fevers, bilateral axillary lymphadenopathy, and a 7.7 kg (12%) total body weight loss over 3 months. Recently, he has not been able to work because of fatigue. Physical examination reveals a 3.5 cm left axillary mass, enlarged cervical, axillary, and inguinal lymph nodes, splenomegaly, and no hepatomegaly.
Other presentations
Clinical presentation is often vague and can be very diverse, ranging from asymptomatic or minimally symptomatic (e.g., painless enlarged lymph nodes) in those with an indolent NHL (e.g., follicular lymphoma) to acute presentation with an aggressive NHL (e.g., diffuse large B-cell lymphoma).
Patients with aggressive NHL or advanced-stage disease may present with the following: B symptoms (fever, night sweats, and weight loss); fatigue/malaise; chest pain; shortness of breath; cough; abdominal discomfort or pain; headache/change in mental status; focal neurological deficits (e.g., ataxia, cognitive changes, and focal weakness); bone pain; back pain; breast pain; or metabolic abnormalities (acute renal failure, tumour lysis syndrome, hypercalcaemia).[3]Hingorjo MR, Syed S. Presentation, staging and diagnosis of lymphoma: a clinical perspective. J Ayub Med Coll Abbottabad. 2008 Oct-Dec;20(4):100-3.
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[4]Wang G, Chang Y, Wu X, et al. Clinical features and prognostic factors of primary bone marrow lymphoma. Cancer Manag Res. 2019;11:2553-63.
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[5]Yu Y, Dong X, Tu M, et al. Primary mediastinal large B cell lymphoma. Thorac Cancer. 2021 Nov;12(21):2831-7.
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[6]Savage KJ, Chhanabhai M, Gascoyne RD, et al. Characterization of peripheral T-cell lymphomas in a single North American institution by the WHO classification. Ann Oncol. 2004 Oct;15(10):1467-75.
https://www.annalsofoncology.org/article/S0923-7534(19)51047-X/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/15367405?tool=bestpractice.com
[7]Cadranel J, Wislez M, Antoine M. Primary pulmonary lymphoma. Eur Respir J. 2002 Sep;20(3):750-62.
https://publications.ersnet.org/content/erj/20/3/750
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[8]Kaji D, Ota Y, Sato Y, et al. Primary human herpesvirus 8-negative effusion-based lymphoma: a large B-cell lymphoma with favorable prognosis. Blood Adv. 2020 Sep 22;4(18):4442-50.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7509864
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[9]Khdhir M, El Annan T, El Amine MA, et al. Complications of lymphoma in the abdomen and pelvis: clinical and imaging review. Abdom Radiol (NY). 2022 Aug;47(8):2937-55.
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[10]Schaff LR, Grommes C. Primary central nervous system lymphoma. Blood. 2022 Sep 1;140(9):971-9.
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[11]Müller A, Dreyling M, Roeder F, et al. Primary bone lymphoma: clinical presentation and therapeutic considerations. J Bone Oncol. 2020 Dec;25:100326.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7554647
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[12]Monnard V, Sun A, Epelbaum R, et al. Primary spinal epidural lymphoma: patients' profile, outcome, and prognostic factors: a multicenter Rare Cancer Network study. Int J Radiat Oncol Biol Phys. 2006 Jul 1;65(3):817-23.
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[13]Jaffe ES, Ashar BS, Clemens MW, et al. Best practices guideline for the pathologic diagnosis of breast implant-associated anaplastic large-cell lymphoma. J Clin Oncol. 2020 Apr 1;38(10):1102-11.
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[14]Opyrchal M, Figanbaum T, Ghosh A, et al. Spontaneous tumor lysis syndrome in the setting of B-cell lymphoma. Case Rep Med. 2010;2010:610969.
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[15]Belay Y, Yirdaw K, Enawgaw B. Tumor lysis syndrome in patients with hematological malignancies. J Oncol. 2017;2017:9684909.
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