Jorge E. Romaguera, MD

M.D. Anderson Cancer Center, University of Texas, Houston, TX

Copyright of the American Society of Hematology, 2006. ISSN: 1931-6860.

This case was reviewed and updated in January 2011 by Dr. Peter Marks and members of the Teaching Cases Subcommittee.


  1. Several disease processes can result in lymphadenopathy. Infectious etiologies should be excluded first (e.g., by Monospot and PPD tests to rule out EBV mononucleosis and tuberculosis respectively). A detailed history and physical examination is essential.
  2. Signs and symptoms of non-Hodgkin lymphoma (NHL) can be non-specific and are usually of minimal help in obtaining a specific diagnosis. Constitutional symptoms may include fever, night sweats, and weight loss.
  3. If no infection can be found, the diagnosis of lymphoma should be considered, and the diagnostic procedure of choice is excisional biopsy. Fine needle aspirations are less invasive, but not adequate to examine nodal architecture.
  4. The classification of non-Hodgkin lymphoma has been a challenge for many decades. Basically, lymphoma arises from an accumulation of mutations resulting in transformation of a lymphoid lineage cell. The malignant cells usually maintain many features of the specific stage of lymphoid development from which the clone arose. The most recent classification scheme (WHO system) utilizes multiple techniques, including morphology, immunostaining and molecular studies to obtain a specific diagnosis.
  5. Aggressive non-Hodgkin lymphoma should be treated upon diagnosis with multi-agent chemotherapy such as cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), often combined with the anti-CD20 antibody rituximab. Even patients with advanced stage disease can be cured with this approach.
  6. Low-grade NHL is incurable in most cases. Patients with low-grade NHL can be observed without therapy until they develop bulky or symptomatic lymph node or organ involvement.

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