Pediatric emergency medicine trisk 2687 2687

Lymphoma

Typical presentation

Potential complications at
diagnosis and
considerations for ED
management

Hodgkin disease

Painless, hard adenopathy:
neck and supraclavicular
common
AMM common, with or
without symptoms
Pleural effusions uncommon
May have “B” symptoms
Fevers
Night sweats
Weight loss (at least 10%
weight loss)

Superior vena cava (SVC)
syndrome
Tracheal obstruction

Lymphoblastic
lymphoma

Painless, hard adenopathy at

any site
Respiratory symptoms from
rapidly growing
mediastinal mass, often
with pleural effusions (Tlineage, advanced stage)
GI tract involvement rare

Tumor lysis syndrome (TLS)
SVC syndrome
Tracheal obstruction
Pleural effusions

Burkitt lymphoma

Single site of enlarged
lymphoid tissue (low
stage)
Incidental finding on
appendectomy
Asymmetric enlarged
tonsil
Lead point for
intussusception in >3 yrs
A single, painless enlarged
node
Painless, hard adenopathy
with rapid growth (usually
advanced stage)

Rapid assessment for TLS:

High risk of severe tumor
lysis, even prior to
treatment (advanced stage)
First dose rasburicase in ED
if uric acid >8 and low risk
for G6PD deficiency
Urgent consultation with
oncology
Admission to center with
available pediatric dialysis