A Case of Nodal Marginal Zone Lymphoma Presenting as Left Leg Swelling

TL;DR

A 63-year-old woman with left leg swelling was diagnosed with a rare type of lymphoma after multiple biopsies.

Contribution

This case study adds to the limited literature on nodal marginal zone lymphoma with an unusual presentation.

Findings

NMZL presented as left leg swelling rather than typical widespread lymphadenopathy.

A repeat biopsy was necessary for accurate diagnosis after an initial alternative diagnosis.

The patient chose active surveillance over immediate therapy due to an indolent disease course.

Abstract

Nodal marginal zone lymphoma (NMZL), a rare subtype of non-Hodgkin lymphoma, typically presents with widespread lymphadenopathy, often without constitutional symptoms or extranodal involvement. Here is a case of a 63-year-old woman who presented with left leg swelling and was found to have bulky lymphadenopathy on imaging. After an initial lymph node biopsy revealed an alternate diagnosis, a repeat biopsy was pursued, given the high suspicion for malignancy. Given her indolent disease course and lack of significant symptoms, the patient opted to defer systemic therapy in favor of active surveillance with close monitoring. This case highlights the challenges in the diagnosis of NMZL.

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