A 25 year old male is referred for the evaluation of head and neck lymphadenopathy in the context of weight loss and malaise.
Consider the following points for discussion:
- What are B symptoms?
- What type of specimen would be required to confirm a diagnosis of lymphoma?
- Discuss the differential diagnosis of lymphadenopathy.
The B symptoms are:
- Unexplained loss of more than 10% of body weight in the 6 months before diagnosis.
- Unexplained fever >38 degrees C.
- Drenching night sweats.
The single most useful diagnostic test is a representative, technically adequate, and properly evaluated biopsy, with either an excisional or Core biopsy. An FNA is not acceptable for a diagnosis of lymphoma.
A differential diagnosis for lymphadenopathy is shown below:
| Reactive | Inflammatory | Neoplastic |
| Bacterial (any infection, TB, Lyme, brucellosis, cat-scratch disease) | Collagen vascular disease (RA, dermatomyositis, SLE, vasculitis, Sjögren) | Lymphoproliferative disorder/Lymphoma |
| Viral (EBV, CMV, HIV) | Drug hypersensitivity | Metastatic cancer |
| Parasitic (toxoplasmosis) | Sarcoidosis, amyloidosis, Kikuchi’s disease | Langerhans Histiocytosis |
| Fungal (histoplasmosis) | Serum sickness |
