Clinical manifestations of malignant lymphoma

The clinical manifestations of malignant lymphoma are mainly divided into systemic symptoms and symptoms caused by tumor invasion. Systemic symptoms mainly include fatigue, weight loss, fever and skin itching. The systemic symptoms of different pathological types are different. Anaplastic large cell lymphoma has more obvious systemic symptoms, while lymphoblastic lymphoma and B-cell lymphoma have no obvious systemic symptoms. The symptoms caused by tumor invasion vary greatly depending on the pathological type of the disease, the location of the tumor and the stage. Usually lymphadenopathy is the basic feature of this disease, and the painless and progressive enlargement of superficial lymph nodes is often the first manifestation. Extranodal lesions can occur in different parts of the liver, spleen, stomach, intestines, tonsils, lungs, kidneys, bones, bone marrow, central nervous system, skin, etc., showing different symptoms and signs. According to different pathological types, the clinical symptoms also have their own characteristics;

1. T (B) lymphoblastic lymphoma/leukemia accounts for about 35%-40% of childhood lymphoma. Its clinical characteristics are that it often occurs in older male children. In addition to multiple lymph node enlargement, there are often huge anterior mediastinal masses and pleural effusions. The compression of the tumor often causes superior vena cava compression syndrome and dyspnea, which is also the main cause of emergency and early death in patients with lymphoma. In addition, this type of lymphoma is very easy to spread to the bone marrow, peripheral blood and central nervous system, and cervical and abdominal lymph node enlargement is also common. The clinical progression is fast, and usually 70% of patients have bone marrow metastasis-lymphosarcoma leukemia when diagnosed. In addition to the manifestations of lymphoma, patients with lymphosarcoma leukemia often have anemia, bleeding, and hepatomegaly and splenomegaly, which are manifestations of leukemia.

2. B-cell lymphoma Children often have Burkitt's or Burkitt-like lymphoma, which accounts for about 30%-35% of childhood lymphoma, and diffuse large B-cell lymphoma is less common. Unlike African lymphoma, the most common primary site of Burkitt's or Burkitt-like lymphoma in my country is abdominal lymphadenopathy or abdominal tumors, so clinical manifestations of acute abdomen such as abdominal pain, ascites, peritonitis, recurrent intussusception or intestinal perforation, and intestinal bleeding are common. This type is clinically dangerous and progresses rapidly. It is very easy to spread to the liver, spleen, kidney, bone marrow and central nervous system. The maxillofacial area, nasopharyngeal cavity and tonsils are also the parts that this type often invades, manifesting as nasal congestion, dyspnea and recurrent tonsillitis. If it metastasizes to the bone marrow, it is usually a manifestation of multi-cavitating L3 leukemia.

3. Anaplastic large cell lymphoma Anaplastic large cell lymphoma is a group of highly heterogeneous lymphomas. Due to its special clinical manifestations, it is easy to misdiagnose. In addition to the common B symptoms such as fever, its clinical manifestations are also characterized by the common occurrence of extranodal lymphoma, which can occur in the bones and cause bone defects, skin invasion, subcutaneous nodules or rashes, and interstitial lung changes. Masses in the ileocecal region and enlarged lymph nodes in the neck, axilla or groin can also be seen, and masses in the anterior mediastinum or nasopharynx are occasionally seen. CNS metastasis and progression to leukemia are rare, but the bone marrow often shows mutations in lymphoid tissue cells.

4. Peripheral T/NK cell lymphoma, panniculitis T cell lymphoma often presents with systemic symptoms such as fever, and specific skin lesions are more common with diverse manifestations, including lumps, subcutaneous nodules, infiltrative plaques, ulcers, papules, macules, etc. Clinical manifestations such as liver and spleen enlargement, pleural effusion, peritoneal effusion, facial edema, and jaundice may also be seen.