The epitrochlear lymph node: an unusual physical finding in lymphoma with important clinical significance.

An 82-year-old Caucasian female was evaluated for a right breast mass detected by mammography. Her past medical history of patient included HTN, Type 2 diabetes mellitus, and rheumatoid arthritis. The patient denied breast pain, trauma or discharge from the nipple. She admitted to fevers, sweats, 30 lb weight loss, generalized weakness, and fatigue for 6 months. There was no history of animal bites or scratches or syphilis or HIV exposure. On physical examination generalized bilateral lymphadenopathy involving cervical, supraclavicular, axillary and inguinal lymph nodes were identified. The lymph nodes were mobile and non-tender. In addition a right mobile, nontender epitrochlear nodule measuring 4 X 4 cm was noted. Her cardiopulmonary examination was unremarkable. On abdominal examination splenomegaly was noted. The patient underwent an excisional biopsy of right axillary lymph nodes that revealed diffuse large cell B cell lymphoma. She was clinical stage as IIIB non-Hodgkins lymphoma. The treatment with total nodal irradiation and subsequent four-drug combination chemotherapy under a protocol was begun. Lymphomas are malignant neoplasms of cells native to lymphoid tissues. Like other neoplasms they are of monoclonal origin as can be documented by clone gene rearrangement and surface markers by flow cytometry. Lymphomas are segregated as Hodgkins lymphoma, by the presence of distinctive unifying morphologic feature the Reed-Sternberg giant cells, and non-Hodgkins lymphoma. Lymphomas often produce marked nodal enlargement that is almost always non-tender. Epitrochlear nodes involvement is a rare occurrence in both Hodgkins or non-Hodgkins lymphomas, either as the sole site of involvement or as part of more widespread disease. Only very limited information is available on association of epitrochlear nodes and lymphomas. A literature search revealed only a few isolated case studies. Epitrochlear nodes are noted in about 0.088% of Hodgkins lymphoma and indicates diffuse disease. Epitrochlear lymph node involvement is more common in the non-Hodgkins lymphoma and is a peculiar a site of relapse in these patients. We report here a patient who presented with epitrochlear node involvement with diffuse large B-cell non-Hodgkins lymphoma and emphasize the clinical importance of this physical finding.

A.K. Goli, MD, S.A. Goli, MD, M. Koduri, MD, Ryland P. Byrd, Jr, MD, and Thomas M. Roy, MD. Department of Medicine, James H. Quillen College of Medicine, Mountain Home, Johnson City, TN.