Non-Hodgkin's lymphoma

Background

• Can originate in lymphatic system or any organ in the body
• Occurs in children >5 years old
• Immunosuppression (e.g. HIV, crohn's, chemotherapy) is a risk factor

Clinical Features

• Lymphadenopathy
• Hepatosplenomegaly
• "B" symptoms (fever, night sweats, weight loss)
• GI: GI bleed, intussusception, nausea/vomiting
• Signs/symptoms of complications:
  • Superior vena cava syndrome
  • Pleural effusion, pericardial effusion
  • Malignant cord compression
  • Tumor lysis syndrome (rare in absence of active treatment)

Differential Diagnosis

Cervical Lymphadenopathy

• Hodgkin's lymphoma
• Non-Hodgkin's lymphoma
• Mononucleosis
• Toxoplasmosis
• Branchial cleft lesions
• Cat scratch disease
• Mycobacterial adenitis

Acute Leukemia/Lymphoma

• Acute myeloid leukemia
• Acute lymphocytic leukemia
• Hodgkin's lymphoma
• Non-Hodgkin's lymphoma

Lymphadenitis

Infectious

• Reactive adenitis
• Bacterial lymphadenitis
• Tuberculous lymphadenitis
• Cellulitis
• Cat-scratch disease
• Parotitis
  • Suppurative parotitis
  • Viral parotitis
• Lymphangitis
• Toxoplasmosis
• Tularemia
• Viral disease
  • HIV-AIDS
  • Cytomegalovirus
  • Epstein-Barr Virus
• Fungal disease
• Reactive adenitis

Non-Infectious

• Malignancy
  • Lymphoma
  • Metastatic cancer
• Rheumatologic Disease
  • Kawasaki Disease
  • Systemic lupus erythematosus
  • Sarcoidosis
  • Juvenile Idiopathic Arthritis
  • Langerhans Cell Histiocytosis
• Cutaneous Lesions:
  • Bacillary angiomatosis
  • Purpura
  • Hematomas
  • Angiomas
  • Dermatofibromas
  • Nevi
• Drug reaction
  • Phenytoin or Carbamazepine
• Postvaccination
• Sarcoidosis
• Salivary gland diagnoses

Evaluation

• CBC
• BMP, LFTs, uric acid
• CXR

Management

See management sections of specific complications:

• Superior vena cava syndrome
• Pleural effusion, pericardial effusion
• Malignant cord compression
• Tumor lysis syndrome
• Neutropenic fever
• Nausea/vomiting
• GI bleeding, intussusception

See Also

• Lymphoma
• Oncologic emergencies