Unusual Presentation of Non-Hodgkin’s B-Cell Lymphoma with Unilateral Right Limb Lymphedema


Background: In clinical practice and setting of general practice it is common to see patients with leg edema. To correctly identify the etiology of the edema and then properly manage the cause is not always easy. The unilateral lymphedema of the lower limb has rarely been reported as an initial presentation for lymphoma, especially in females, usually without classic signs or symptoms, but often with inguinal lymphadenopathy or abdominal masses. Case Report: In this article, we report a rare case of unilateral lower limb edema in a healthy obese woman who complained about the appearance of the disease for several months and for whom deep vein thrombosis and other diseases had been excluded. The histological examination of the biopsy of an enlarged lymph node in the right groin, which was compressing the iliac and femoral vein, revealed the presence of B cell non-Hodgkin lymphoma with high-grade malignancy. Conclusions: A common challenge for primary care physicians is to determine the cause and find an effective treatment for leg edema of unclear etiology. Non-Hodgkin’s B-cell Lymphoma should be considered in the differential diagnosis in patients with unilateral leg edema when the swelling is chronic and deep venous thrombosis is promptly excluded.

Share and Cite:

Bolognesi, M. and Bolognesi, D. (2014) Unusual Presentation of Non-Hodgkin’s B-Cell Lymphoma with Unilateral Right Limb Lymphedema. Case Reports in Clinical Medicine, 3, 577-582. doi: 10.4236/crcm.2014.311125.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Gorman, W.P., Davis, K.R. and Donnelly, R. (2000) ABC of Arterial and Venous Disease. Swollen Lower Limb-1: General Assessment and Deep Vein Thrombosis. BMJ, 320, 1453-1456.
[2] Mortimer, P.S. (2000) Swollen Lower Limb-2: Lymphoedema. BMJ, 320, 1527-1529.
[3] Szuba, A. and Rockson, S.G. (1998) Lymphedema: Classification, Diagnosis, and Therapy. Vascular Medicine, 3, 145-146.
[4] Yale, S.H. and Mazza, J.J. (2001) Approach to Diagnosing Lower Extremity Edema. Comprehensive Therapy, 27, 242-252.
[5] Smith, R.D., Spittel, J.A. and Schirger, A. (1963) Secondary Lymphedema of the Leg: Its Characteristics and Diagnostic Implications. JAMA, 185, 116-118
[6] Kinmonth, J.B., Taylor, G.W., Tracy, G.D. and Marsh, J.D. (1957) Primary Lymph-Oedema. Clinical and Lymphangiographic Studies of a Series of 107 Patients in Which the Lower Limbs Were Affected. British Journal of Surgery, 45, 1±10.
[7] Akritidis, N. and Baxevanos, G. (2007) Unilateral Lymphoma-Related Leg Edema. Journal of Clinical Oncology, 25, 5523-5524
[8] Fijten, G.H. and Blijham, G.H. (1988) Unexplained Lymphadenopathy in Family Practice. An Evaluation of the Probability of Malignant Causes and the Effectiveness of Physicians’ Workup. The Journal of Family Practice, 27, 373-376.
[9] Harry, L. and Loachim, J.B. (1994) Lymph Node Pathology. 2nd Edition, Olippincott Company, Philadelphia.
[10] Ferrer, R. (1998) Lymphadenopathy: Differential Diagnosis and Evaluation. American Family Physician, 58, 1315.
[11] Tiwari, A., Cheng, K.S., Button, M., Myint, F. and Hamilton, G. (2003) Differential Diagnosis, Investigation, and Current Treatment of Lower Limb Lymphedema. JAMA Surgery, 138, 152-161.
[12] Mauch, P.M., Kalish, L.A., Kadin, M., Coleman, C.N., Osteen, R. and Hellman, S. (1993) Patterns of Presentation of Hodgkin Disease. Implications for Etiology and Pathogenesis. Cancer, 71, 2062-2071.
[13] Rigas, A., Kostakis, A., Safioleas, M., Vaos, G., Zonas, C. and Skalkeas, G. (1981) Lymphedema as the First Manifestation of Hodgkin’s Disease. Lymphology, 14, 138-140.
[14] Halilbasic, A., Mesic, E., Cikusic, E. and Arnautovic, A. (2006) Non-Hodgkin’s Lymphoma in the North-East Bosnia: Changes in Biological Aggressiveness and Primary Presentation of the Disease. Medicinski Arhiv (Medical Archives), 60, 78-83.
[15] Shankland, K.R., Armitage, J.O. and Hancock, B.W. (2012) Non-Hodgkin Lymphoma. Lancet, 380, 848-857.
[16] Sajid, T., Intisar-ul-Haq, Haq, I. and Chaudhary, A.K. (2009) An Obscure Cause of Leg Edema, Non-Hodgkin’s Lymphoma. Journal of the College of Physicians and Surgeons—Pakistan, 19, 254-256.
[17] Hawkins, K.A., Amorosi, E.L. and Silber, R. (1980) Unilateral Leg Edema. A Symptom of Lymphoma. JAMA, 244, 2640-2641.
[18] Armitage, J.O. (2007) How I Treat Patients with Diffuse Large B-Cell Lymphoma. Blood, 110, 29-36.
[19] Dunphy, C.H. and Ramos, R. (1997) Combining Fine-Needle Aspiration and Flow Cytometric Immunophenotyping in Evaluation of Nodal and Extranodal Sites for Possible Lymphoma: A Retrospective Review. Diagnostic Cytopathology, 16, 200-206.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.