Characteristics of patients with lymphoma presenting initially as a neck mass referral to otolaryngology.

Abstract

e18054 Background: Lymphomas that present initially as a neck mass can be challenging to diagnose as their onset is often insidious, frequently without classic symptoms, and fine-needle aspiration has limited utility for diagnosis. Understanding their clinical presentation may facilitate recognition and diagnosis, essential for timely treatment of aggressive lymphoma subtypes. Methods: Using data from a large integrated healthcare delivery system, adults aged 18-89 years without known previous cancer who were referred to Head and Neck Surgery for evaluation of a “neck mass” in 2017 were identified. Among the subset of 205 patients found to have malignancy, 76 had lymphoma (N = 69) or leukemia (N = 7) and 129 had a non-lymphoma/leukemia malignancy. The demographic characteristics of patients with and without lymphoma/leukemia were compared. Among the 69 with lymphoma, tumor histology and stage were examined. Differences between subgroups were compared using Chi-squared, Fisher’s exact, Student’s t-test, F-tests, and Tukey’s range tests for pairwise comparison. Results: Among 205 patients identified with a malignant neck mass, 76 (37%) were diagnosed with lymphoma/leukemia. Patients with lymphoma/leukemia were more likely to be female (47% vs. 27%, p = 0.003) and under age 50 years (36% vs. 13%, p = 0.001). There were no statistically significant differences in race, smoking status, or BMI between the two groups. Among the lymphoma/leukemia subset, 18 (24%) had Diffuse Large B-Cell Lymphoma (DLBCL), 13 (17%) had Follicular Lymphoma (FL), and 25 (33%) had Hodgkin’s Lymphoma (HL). The HL subset was significantly younger than both the FL and DLBCL subsets (mean age 41.6 years vs. 62.2 and 66.6, p < 0.001). A range of findings was seen when examining sex (72%, 44% and 46% male), race/ethnicity (60%, 72% and 69% non-Hispanic White), smoking status (36%, 33% and 62% current/former) and tumor stage at presentation (52%, 50% and 69% late stage (III-IV)) for HL, DLBCL and FL subtypes, respectively, but the differences were not statistically significant in these smaller subsets. Conclusions: Significant differences in baseline characteristics exist between lymphoma and non-lymphoma patients presenting with a malignant neck mass. Notably, the lymphoma subset was younger and, except for those with HL, did not demonstrate a male predominance. Within the lymphoma subset, HL patients were significantly younger than patients with other lymphoma subtypes. Further studies in a larger population identifying demographic differences by cancer subtype may inform efforts to prevent diagnostic delays in head and neck lymphoma. Characterizing the diagnostic pathway is also needed to quantify room for improvement in the treatment approach of patients with neck mass considered at higher risk for lymphoma.