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Clinical presentation and diagnosis of non-Hodgkin lymphoma

Arnold S Freedman, MD
Jonathan W Friedberg, MD
Jon C Aster, MD
Section Editor
Andrew Lister, MD, FRCP, FRCPath, FRCR
Deputy Editor
Alan G Rosmarin, MD


Non-Hodgkin lymphoma (NHL) consists of a diverse group of malignant neoplasms variously derived from B cell progenitors, T cell progenitors, mature B cells, mature T cells, or (rarely) natural killer cells.

This topic will review the initial evaluation of a patient with suspected NHL. The classification, staging and prognosis of NHL, including specific details on the use of imaging modalities and the diagnosis of individual NHL variants, are discussed separately. (See "Evaluation, staging, and response assessment of non-Hodgkin lymphoma" and "Classification of the hematopoietic neoplasms".)


General — The clinical presentation of NHL varies tremendously depending upon the type of lymphoma and the areas of involvement. Some NHLs behave indolently with lymphadenopathy waxing and waning over years. Others are highly aggressive, resulting in death within weeks if left untreated. In typical cases:

Aggressive lymphomas commonly present acutely or subacutely with a rapidly growing mass, systemic B symptoms (ie, fever, night sweats, weight loss), and/or elevated levels of serum lactate dehydrogenase and uric acid. Examples of lymphomas with this aggressive or highly aggressive presentation include diffuse large B cell lymphoma, Burkitt lymphoma, adult T cell leukemia-lymphoma, and precursor B and T lymphoblastic leukemia/lymphoma.

Indolent lymphomas are often insidious, presenting only with slow growing lymphadenopathy, hepatomegaly, splenomegaly, or cytopenias. Examples of lymphomas that typically have indolent presentations include follicular lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, and splenic marginal zone lymphoma.

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Literature review current through: Nov 2017. | This topic last updated: Jun 26, 2017.
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