Physical Findings

The most common finding on physical examination is adenopathy, which is most easily appreciated in the cervical, axillary, and inguinal regions. Adenopathy is typically symmetric, but may be more prominent in a particular region of the body, such as the neck. If adenopathy is asymmetric, or there is rapid increase in a localized nodal group, suspicion should be raised for Richter transformation. Organomegaly typically involves the spleen; hepatomegaly due to leukemic infiltration is less comman. Although extranodal involvement is rare, patients may develop leukemic infiltrates in the skin,1011 mucosa-associated lymphoid tissue,1213 or lungs.14-16 Central nervous system involvement with leukemia is rare, but can cause headache, meningitis, cranial nerve palsy, mental status changes, or coma.17 The kidneys or collecting system may be involved with leukemia.18-21 This is rare and difficult to document by histology. When present, it may be characterized by a progressive rise in creati-nine that improves following treatment. Overall, patients with extranodal involvement tend to have more aggressive disease and a worse prognosis.

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