Childhood Lymphomas: Signs and Symptoms
Childhood lymphomas present most commonly with painless lymphadenopathy, but the specific symptom pattern depends critically on the anatomic location of disease, with abdominal masses causing gastrointestinal symptoms, intrathoracic masses causing respiratory compromise, and head/neck involvement causing localized swelling or dysphagia. 1
General Presentation Patterns
Common Initial Symptoms
- Painless adenopathy is the typical presenting feature, with lymph node involvement occurring in approximately 79% of cases 1, 2
- Constitutional "B" symptoms include fever, unexplained weight loss, and drenching night sweats, which occur more commonly in advanced disease stages 1, 3
- Fatigue or lethargy develops from bone marrow infiltration and resulting cytopenias 1
- Easy bruising or bleeding results from thrombocytopenia secondary to marrow involvement 1
- Increased susceptibility to infections occurs due to immune dysfunction 1
Age-Specific Considerations
- In the United States, Hodgkin lymphoma incidence is <5 per million in children aged <10 years but increases dramatically to 32.5 per million in adolescents aged 15-19 years, making it the most common malignancy in this age group 1
- Non-Hodgkin lymphoma accounts for 5% of cancers in children aged ≤14 years and 7% in adolescents aged 15-19 years 1
Location-Specific Symptom Complexes
Abdominal/Gastrointestinal Involvement
Patients with abdominal tumors present with: 1
- Abdominal pain or swelling
- Poor appetite or early satiety
- Constipation
- Nausea and/or vomiting
- Abdominal masses (more suggestive of mature B-cell lymphomas like Burkitt lymphoma) 1
Intrathoracic/Mediastinal Masses
Chest involvement causes: 1
- Coughing
- Dyspnea (shortness of breath)
- Wheezing or stridor
- Chest pain
- Reduced exercise tolerance or endurance
- Superior vena cava syndrome (a medical emergency) 1
- Respiratory compromise requiring urgent intervention 1
Head and Neck Involvement
Tumors in the head and neck region manifest as: 1
- Swollen cervical lymph nodes
- Swelling in the neck, jaw, gingival area, or maxilla
- Difficulty swallowing (dysphagia)
- Choking episodes
- Vision changes
Central Nervous System Involvement
CNS disease (present in approximately 9% of pediatric Burkitt lymphoma cases) causes: 1, 4
- Bladder or bowel dysfunction
- Lower extremity weakness
- Headaches
- Cranial nerve involvement leading to chin numbness or facial palsy 1
Musculoskeletal Presentation
- Pain in the extremities or joints may be the only presenting symptom in some children, which can lead to diagnostic delays 1
Physical Examination Findings
Key findings on examination include: 1
- Lymphadenopathy (enlarged lymph nodes)
- Splenomegaly (enlarged spleen)
- Hepatomegaly (enlarged liver)
- These organomegaly findings are present in approximately 20% of patients 1
Emergency Presentations
Critical oncologic emergencies that require immediate recognition and intervention include: 1
- Tumor lysis syndrome
- Superior vena cava syndrome
- Respiratory compromise from mediastinal masses
- Spinal cord compression
Important Clinical Pitfalls
Diagnostic Delays
- Joint or bone pain as the sole presenting symptom can mimic rheumatologic conditions, potentially delaying lymphoma diagnosis 1
- Painless adenopathy may be dismissed as reactive lymphadenopathy from benign infections
Distinguishing Features
- Abdominal masses are more characteristic of mature B-cell lymphomas (Burkitt lymphoma) rather than lymphoblastic lymphoma 1
- Mediastinal masses are particularly common in T-cell acute lymphoblastic leukemia/lymphoma 1
Treatment Setting
All pediatric lymphomas are highly aggressive but curable malignancies requiring complex treatment, and it is strongly preferred that treatment occur at specialized centers with expertise in managing these diseases 1
The 5-year survival rates have improved dramatically, now exceeding 95% for Hodgkin lymphoma and approximately 80-90% for non-Hodgkin lymphoma, making early recognition of symptoms critical for optimal outcomes 1, 5