Clinical presentation and characteristics of lymphoma in the head and neck region

Katharina Storck,Ulrich Keller,Andreas Knopf,Markus Brandstetter

doi:10.1186/s13005-018-0186-0

Katharina Storck, Ulrich Keller + Show 2 more

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https://doi.org/10.1186/s13005-018-0186-0

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Abstract

BackgroundThe study analyses clinical characteristics of histologically defined head and neck (H&N) lymphoma to raise the awareness of ENT specialists to the leading symptoms.MethodFrom 2003 to 2011, all patients with histologically defined H&N lymphoma from our clinic were evaluated.ResultsThis study identified 221 patients with H&N lymphoma comprising 193 non-Hodgkin lymphomas (NHL) and 28 Hodgkin lymphomas (HL). Among NHL there were 77 indolent (iNHL), 110 aggressive (aNHL), six highly aggressive NHL and further 28 HL. Patients with highly aggressive NHL and HL were significantly younger (p < 0.0001). Corresponding to the leading symptoms, we found nodal and extranodal involvement. NHL demonstrated manifestation in neck lymph nodes, tonsils, major salivary glands, sinonasal-system and hypopharynx/larynx. HL showed exclusive manifestation in lymph nodes of the neck and the tonsils (p < 0.0001). The mean time from first symptoms to diagnosis ranged from 1.5 ± 0.7 months in highly aggressive lymphoma to 7.5 ± 11.5 months in iNHL.ConclusionsThe variable clinical presentation of lymphoma is a challenge for the ENT specialist. Fast diagnosis is crucial for rapid treatment, especially in highly aggressive NHL like the Burkitt-lymphoma and HL. A standardized medical history, clinical examination and imaging evaluations paired with patient’s signs, symptoms and demographic knowledge might indicate lymphoma. Biopsies in the H&N region should always be immediately performed in suspicious findings.

Highlights

The study analyses clinical characteristics of histologically defined head and neck (H&N) lymphoma to raise the awareness of ENT specialists to the leading symptoms
Further symptoms of lymphoma might include anaemia, leucopenia/leucocytosis and thrombopenia, specific serum and blood parameters might sometimes suggest indolent vs aggressive lymphoma, e.g. elevated lactate dehydrogenase (LDH) in cases of highly proliferative disease or increased β2-microglobulin
Epidemiology and characteristics of the head and neck cohort A total of 221 patients were included in this study: 193 with non-Hodgkin lymphomas (NHL) and 28 with Hodgkin lymphomas (HL)

Summary

Introduction

The study analyses clinical characteristics of histologically defined head and neck (H&N) lymphoma to raise the awareness of ENT specialists to the leading symptoms. The clinical behaviour and manifestations of lymphomas in the head and neck region usually lack specific characteristics that would enable attribution to a specific lymphoma entity without biopsy and histological evidence. Further symptoms of lymphoma might include anaemia, leucopenia/leucocytosis and thrombopenia, specific serum and blood parameters might sometimes suggest indolent vs aggressive lymphoma, e.g. elevated lactate dehydrogenase (LDH) in cases of highly proliferative disease or increased β2-microglobulin. The most important differential diagnosis for head and neck lymphadenopathy is infection or lymph-node metastasis from regional or distant primaries being affected by solid cancer

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