Differential Diagnosis for 71-Year-Old Woman with Bilateral Axillary Swelling
Single Most Likely Diagnosis
- Lymphoma: Given the patient's age, gradual onset of symptoms, presence of bilateral axillary swelling, "lumps" on the neck, and significant adenopathy in multiple regions as shown on CT scans, lymphoma is a highly plausible diagnosis. The enlargement of lymph nodes over time and the presence of systemic symptoms like fatigue also support this diagnosis.
Other Likely Diagnoses
- Chronic Lymphocytic Leukemia (CLL): The patient's lymphocytosis, although mild, combined with the presence of adenopathy and splenomegaly, could suggest CLL. However, the lack of significant lymphocytosis in the blood and the presence of larger lymph nodes might lean more towards lymphoma.
- Metastatic Cancer: Given the family history of colon cancer and the presence of widespread adenopathy, the possibility of a metastatic cancer, potentially from a gastrointestinal primary, should be considered. However, the absence of weight loss, fever, or other systemic symptoms and the lack of a clear primary tumor on imaging makes this less likely.
- Sarcoidosis: This condition can cause lymphadenopathy and systemic symptoms. However, the absence of pulmonary symptoms or findings on the lung exam and the lack of other typical sarcoidosis manifestations make this diagnosis less likely.
Do Not Miss Diagnoses
- Hodgkin Lymphoma: Although less common than non-Hodgkin lymphoma in this age group, Hodgkin lymphoma can present with lymphadenopathy and systemic symptoms. It is crucial to consider this diagnosis due to its potential for cure with appropriate treatment.
- Tuberculosis or Other Infectious Diseases: Although the patient reports no recent travel or sick contacts, and the physical exam does not strongly suggest an infectious process, tuberculosis or other chronic infections can cause lymphadenopathy. These diagnoses are critical to rule out due to their treatability.
- Rheumatologic Diseases (e.g., Rheumatoid Arthritis, Lupus): These conditions can cause lymphadenopathy and systemic symptoms. While they might be less likely given the patient's presentation, they are important to consider due to their impact on quality of life and the availability of treatment.
Rare Diagnoses
- Castleman Disease: A rare disorder that can cause lymphadenopathy, systemic symptoms, and can be associated with lymphoma. It is less likely but should be considered in the differential due to its unique treatment approach.
- Kikuchi-Fujimoto Disease: A rare, self-limiting condition that causes lymphadenopathy, typically in the neck, and can be accompanied by systemic symptoms. It is more common in younger individuals but should be considered in the differential for unexplained lymphadenopathy.
- Lymphoproliferative Disorders Associated with Immunodeficiency: Conditions such as autoimmune lymphoproliferative syndrome (ALPS) are rare and typically present in younger individuals but could be considered in the differential for persistent, unexplained lymphadenopathy.