Non-Hodgkin’s Lymphoma: Symptoms, Complaints, Signs

The following symptoms and complaints may indicate non-Hodgkin’s lymphoma (NHL):

Leading symptoms

  • Painless lymphadenosis/lymphadenopathy (lymph node enlargement).

Associated symptoms

  • Fatigue
  • Anorexia (loss of appetite)
  • Nausea
  • Heartburn
  • Increased susceptibility to infections
  • Increased bleeding tendency
  • Anemia (anemia)
  • Splenomegaly (spleen enlargement)
  • Hepatomegaly (liver enlargement)
  • Pruritus (itching; in part) [pruritus is an exclusion criterion for B-cell lymphoma].

Associated symptoms of mediastinal lymphoma* .

  • Cough
  • Hoarseness
  • Dysphagia (swallowing disorder)
  • Thoracic pain (chest pain)
  • Phrenic nerve palsy (paralysis of the diaphragm)
  • Upper influence congestion in superior vena cava syndrome (VCSS) – symptom complex resulting from venous outflow obstruction of the superior vena cava (VCS; superior vena cava); clinical presentation:
    • Congested and dilated veins of the neck (jugular venous congestion), head and arms.
    • Feeling of pressure in the head or neck
    • Cephalgia (headache)
    • Other symptoms depending on the cause: dyspnea (shortness of breath), dysphagia (difficulty swallowing), stridor (whistling breathing sound that occurs during inhalation and/or exhalation), cough, cyanosis (bluish discoloration of the skin and mucous membranes).

* Applies to Hodgkin’s lymphoma and primary mediastinal B-cell lymphoma. B symptomatology (in circa 20% of cases).

  • Unexplained, persistent, or recurrent fever (> 38 °C).
  • Severe night sweats (wet hair, soaked sleepwear).
  • Unwanted weight loss (> 10% percent of body weight within 6 months).

Note: The most common indolent lymphoma in adults is follicular lymphoma. Also in the group of indolent lymphomas is mantle cell lymphoma (B-cell lymphoma).

The following symptoms and medical conditions may indicate mantle cell lymphoma (MCL):

  • Lymphadenopathy (lymph node enlargement).
  • Splenomegaly (spleen enlargement)

Bone marrow infiltration is present in approximately 80-90%, and lymphoma cells are detected in the blood in 20-30% of cases.

Primary cutaneous lymphomas Cutaneous T-cell lymphomas (approximately 70% of all primary cutaneous lymphomas)

The following symptoms and complaints may indicate mycosis fungoides (MF):

  • Eczematous lesions (common) suggestive of mycosis (fungal disease)

Localization: trunk and flexor thighs, flexor upper arms v.a. upper third; late stages infestation of the entire outer skin.

For details see below the disease of the same name. The following symptoms and complaints may indicate Sézary syndrome:

  • Erythroderma (extensive reddening of the skin).
  • Pruritus (itching), very agonizing
  • Lymphadenopathy (lymph node enlargement).
  • Facies leonina – facial features are coarsened by nodularity in the cutis and hypodermis,the eyebrow region, cheeks and chin area are swollen like a bulge
  • Palmoplantar hyperkeratosis (“affecting the palms of the hands (palma manus) and soles of the feet (planta pedis)” excessive keratinization of the skin), onychodystrophy (fingernails or toenails show a growth or nutritional disorder (dystrophy)) and alopecia (hair loss) [common].

Localization: generalized

Cutaneous B-cell lymphomas (approximately 25% of all primary cutaneous lymphomas).

The following symptoms and complaints may indicate follicular germinal center lymphoma (primary cutaneous follicular germinal center lymphoma, PCFCL):

  • Skin-colored to reddish shiny nodules (3.0-5.0 cm), usually solitary or confluent like a cushion; indurated palpable; ulceration (“ulceration”) is rare
  • Larger nodes on the hairy head

Localization: main localization is the face (> 90%); trunk, capillitium (hairy scalp).

The following symptoms and complaints may indicate marginal zone lymphoma (PCMCL):

  • Red or red-brownish nodules or plaques (“plate-like” substance proliferation of the skin elevating above the skin level) of various sizes (prominent or palpable subcutaneously indurated).
  • Occurrence in different sizes individually standing and from countable to innumerable distributed over the entire outer skin; if generalized then urticarial associated with a strong pruritus (itching).
  • Ulceration is rare

Localization: trunk and extremities; preferentially on the upper extremity.