Case Report

Unilateral Lower Extremity Swelling as an Unusual Presentaton of Non-Hodgkin’s B-Cell Lymphoma

Abstract

Non-Hodgkin’s B-cell lymphoma is a hematological condition with different types based on clinical presentation, pathological features, and therapeutic response, like Diffuse Large B-cell Lymphoma (DLBCL), follicular lymphoma, and Chronic Lymphocytic Leukemia (CLL). We report A 33-year-old male presented with a complaint of unilateral leg swelling, firstly supposed to be a Deep Vein Thrombosis (DVT); however, in multiple Doppler ultrasonography, DVT was ruled out. The patient’s precise history revealed a swollen mass in the left knee region for two months that slowly enlarged and was confirmed with a physical examination. Doppler ultrasonography of the lower extremities conducted in our center presented no sign of deep vein thrombosis; however, it demonstrated some complex conglomerate lymph nodes in the left inguinal compressing the ipsilateral femoral and iliac vein. It also revealed bulky adenopathy, with a 95×65 mm left knee mass. The performed biopsy reported the existence of malignant lymphoma, suggesting the existence of DLBCL. Consequently, he was referred to a hematology/oncology department for appropriate treatment. This unusual presentation of DLBCL and the importance of noticing an accurate history taking and physical examination, instead of conducting unnecessary paraclinical tests (several Doppler ultrasonography in this case), have led us to report this case.

[1] Trayes KP, Studdiford JS, Pickle S, Tully AS. Edema: Diagnosis and management. American Family Physician. 2013; 88(2):102-10. [PMID]
[2] Ely JW, Osheroff JA, Chambliss ML, Ebell MH. Approach to leg edema of unclear etology. Journal of the American Board of Family Medicine: JABFM. 2006; 19(2):148-60. [DOI:10.3122/jabfm.19.2.148] [PMID]
[3] Elgendy IY, Lo MC. Unilateral lower extremity swelling as a rare presentaton of Non-Hodgkin’s Lymphoma. BMJ Case Reports. 2014; 2014:bcr2013202424. [DOI:10.1136/bcr-2013-202424] [PMID] [PMCID]
[4] Shankland KR, Armitage JO, Hancock BW. Non-hodgkin lymphoma. Lancet. 2012; 380(9844):848-57. [DOI:10.1016/S0140- 6736(12)60605-9] [PMID]
[5] Müller AM, Ihorst G, Mertelsmann R, Engelhardt M. Epidemiology of Non-Hodgkin’s Lymphoma (NHL): Trends, geographic distributon, and etology. Annals of Hematology. 1012; 84(1):1-12. [DOI:10.1007/s00277-004-0939-7] [PMID]
[6] Bray I, Brennan P, Boffeta P. Recent trends and future projectons of lymphoid neoplasms: A Bayesian age-period-cohort. Cancer Causes Control. 2015; 12(9):813-20. [DOI:10.1023/A:1012240117335] [PMID]
[7] Goodman CC, Snyder K. Differental diagnosis for physical therapists: Screening for referral. 5th ed. Philadelphia: WB Saunders; 2003. htps://www.amazon.com/Differental-Diagnosis-PhysicalTherapists-Screening/dp/1437725430
[8] Sajid T, Intsar-ul-Haq, Haq I, Chaudhary AK. An obscure cause of leg edema, Non-Hodgkin's Lymphoma. Journal of the College of Physicians and Surgeons--Pakistan: JCPSP. 2009;19(4):254-6. [PMID]
[9] Mey U, Hitz F, Lohri A, Pederiva S, Taverna C, Tzankov A, et al. Diagnosis and treatment of Diffuse Large B-cell Lymphoma. Swiss Medical Weekly. 2012; 142:w13511. [DOI:10.4414/smw.2012.13511] [PMID]
[10] Gascoyne RD. Establishing the diagnosis of Lymphoma: From inital biopsy to clinical staging. Oncology. 1998; 12(10 suppl 8):11-6. [PMID]
[11] Connors JM, Klimo P, Fairey RN, Voss N. Brief chemotherapy and involved feld radiaton therapy for limited-stage, histologically aggressive Lymphoma. Annals of Internal Medicine. 1987; 107(1):25-30. [DOI:10.7326/0003-4819-107-1-25] [PMID]
[12] Armitage JO. Treatment of Non-Hodgkin’s Lymphoma. The New England Journal of Medicine. 1993; 328(14):1023-30. [DOI:10.1056/ NEJM199304083281409] [PMID]
[13] Goodman CC, Fuller KS. Pathology: Implicatons for the physical therapist. 3rd ed. Amsterdam: Elsevier; 200. htps://www. amazon.com/Differental-Diagnosis-Physical-Therapists-Screening/ dp/1437725430
[14] The Non-Hodgkin’s Lymphoma classifcaton project. A clinical evaluaton of the internatonal Lymphoma study group classifcaton of Non-Hodgkin’s Lymphoma. Blood. 1997; 89(11):3909. [DOI:10.1182/blood.V89.11.3909] [PMID]
Files
IssueVol 6 No 1 (2021) QRcode
SectionCase Report(s)
Published2021-05-15
DOI https://doi.org/10.18502/crcp.v6i1.5953
Keywords
Edema Lymphoma Swelling Diffuse large B-cell lymphoma Lymphadenopathy Venous thrombosis

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Sahraiyan S, Abbaszadeh M, Aminishakib P, Rahmani Tanha R, Karimpour Reyhan S. Unilateral Lower Extremity Swelling as an Unusual Presentaton of Non-Hodgkin’s B-Cell Lymphoma. CRCP. 2021;6(1):15-19.