Swollen lymph nodes • patient is otherwise "healthy" • Dx?

The patient completed R-CHOP and her cancer was in remission one year later.

THE TAKEAWAY

Peripheral lymphadenopathy presents a diagnostic challenge that requires a thorough history and physical exam. General wellness exams should incorporate a comprehensive physical that includes the palpation of lymph nodes. Exam challenges include distinguishing benign lymphadenopathy (reactive lymphadenitis) from malignant lymphadenopathy.

In patients with low risk for malignancy, a period of 4 weeks of observation is reasonable. Biopsy should be considered early for risk factors including patient’s age ≥50, constitutional symptoms, lymphadenopathy >1 cm in >2 regions of the body, history of cancer, or rapidly enlarging nodes.