Aggressive Non-Hodgkin’s Lymphoma: A Case Series and Literature Review

Abstract

Aggressive lymphoma of non-Hodgkin’s type is uncommon. The most common clinical presentation is lymphadenopathy and fever. One-fifth of Non-Hodgkin’s Lymphoma (NHL) present with serous effusions involves the body cavities like pleural, abdominal and pericardial cavities. Ten percent of aggressive lymphomas occur without an underlying immunosuppressive status. The NHL is more common in the elderly with a male preponderance. Paraneoplastic syndromes are rarely associated with non-Hodgkin’s lymphoma. Peritoneal lymphomatosis is extremely rare and associated with a poor prognosis. Since clinical suspicion for underlying malignancy is higher with peritoneal carcinomatosis (than for serous effusion of body cavities), they get recognised early. However, peritoneal lymphomatosis can be neglected and misdiagnosed. This series is about five cases of aggressive non-Hodgkin’s lymphoma. These cases are presented here for their rarity and diverse clinical manifestations. The case of angioimmunoblastic lymphoma was seen in an elderly male who presented with hypoglycaemia serous effusion and lymphadenopathy. Two patients were diagnosed with Natural Killer (NK) cell lymphoma and they presented with serous effusion with a jejunal thickening, as visible in the CT scan. One case of Diffuse Large B Cell Lymphoma (DLBCL) was seen in an elderly female presenting with inguinal lymphadenopathy. Lymphoma shows a varied clinical and radiological presentation and it should always be a differential diagnosis in the massive serous effusion and unexplained bowel thickening in Computed Tomography (CT) imaging with or without lymphadenopathy. The cases reported here emphasise the importance of early pathological diagnosis and immunohistochemical confirmation to ensure that the right treatment can be started at an appropriate time.