ABSTRACT
The overwhelming majority of patients with Hodgkin disease (HD) present with lymph node involvement at diagnosis,1 whereas in one of the first and most complete large series analyzing the clinical data on non-Hodgkin lymphoma (NHL)2 lymphadenopathy was found to be the presenting symptom of ‘lymphosarcoma’ – which mainly included what would nowadays be classified as follicular lymphoma, diffuse large B cell lymphoma and small lymphocytic lymphoma – in 63.5 percent of patients. The percentage of patients with lymph node enlargement at diagnosis varies among different subsets of NHL. In patients with diffuse large cell lymphoma (DLCL), it is the presenting symptom in 84 percent,3 whereas in patients with follicular lymphoma, the commonest type of ‘indolent’ lymphoma, it is present in 90-95 percent,3 the nodes possibly having fluctuated in size for some time prior to the diagnosis.4 More than 90 percent of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) present with lymph node enlargement at diagnosis.3 In contrast, this feature is rarely seen in patients with B pro5
(HCL).6 In the latter the presence of abdominal lymphadenopathy is associated with large immature hairy cells and a worse prognosis related to a relative resistance to treatment, suggesting transformation into a more aggressive disease.7 Anecdotally, lymph node enlargement has been reported to be found in about 10 percent of patients with IgD multiple myeloma.8 Lymph node enlargement can also be found in acute lymphoblastic leukemia (ALL) and other chronic lymphoproliferative disorders.
