Symptoms of Diffuse Large B-Cell Lymphoma (DLBCL)
Patients with DLBCL commonly present with fever, chills, night sweats, unexplained/unintentional weight loss, painless regional or diffuse lymphadenopathy, fatigue, bone pain, and/or irritability. 1
Systemic Symptoms (B Symptoms)
- Fever
- Night sweats
- Unexplained weight loss (>10% of body weight over 6 months)
- Fatigue
- Chills
Nodal Symptoms
- Painless lymphadenopathy (enlarged lymph nodes)
- Can be regional or diffuse
- Most common presenting sign
- Swollen glands in neck, axilla, or groin
Extranodal Involvement
DLBCL frequently presents with extranodal involvement, which can cause site-specific symptoms:
Abdominal Involvement
- Abdominal pain/swelling
- Poor appetite/early satiety
- Constipation
- Nausea/vomiting
Thoracic Involvement
- Coughing
- Dyspnea (shortness of breath)
- Wheezing
- Stridor
- Chest pain
- Reduced endurance
Head and Neck Involvement
- Swelling in neck, jaw, gingival area, or maxilla
- Difficulty swallowing
- Choking
- Vision changes
CNS Involvement
- Bladder or bowel dysfunction
- Lower extremity weakness
- Headaches
Oncologic Emergencies
Patients may present with oncologic emergencies due to rapid tumor growth 1:
- Tumor lysis syndrome
- Superior vena cava syndrome
- Respiratory compromise
- Spinal cord compression
Atypical Presentations
In some cases, DLBCL can present with unusual manifestations:
- Musculoskeletal pain mimicking polymyalgia rheumatica 2
- Bone pain
- Irritability (particularly in pediatric patients)
Diagnostic Considerations
The diagnosis of DLBCL requires:
- Excisional or incisional biopsy of the most accessible site 1
- Immunophenotyping to confirm B-cell lineage 1
- Assessment for specific genetic abnormalities 1
Clinical Pearls
- DLBCL constitutes 30-58% of non-Hodgkin lymphoma cases 1
- The incidence increases with age 1
- Risk factors include family history of lymphoma, autoimmune disease, HIV infection, HCV seropositivity, high body mass as a young adult, and certain occupational exposures 1
- Symptoms may be nonspecific, leading to diagnostic delays
- Approximately 20% of patients present with hepatomegaly or splenomegaly 1
Common Pitfalls
- Mistaking DLBCL for other conditions with similar presentations (e.g., infectious mononucleosis, other lymphomas, autoimmune conditions)
- Relying on fine-needle aspiration alone for diagnosis (excisional biopsy is preferred) 1
- Failing to consider DLBCL in patients with persistent unexplained B symptoms
- Overlooking extranodal manifestations that may be the primary presenting complaint
- Delaying diagnosis in patients with atypical presentations such as isolated musculoskeletal symptoms 2
Early recognition of these symptoms and prompt referral for appropriate diagnostic evaluation are essential for improving outcomes in patients with DLBCL.