Challenging the Presentation Paradigm in DLBCL: A Case Study of Extraordinary Disease Distribution

This case study examines a 55-year-old male without previously known comorbidities, who was evaluated due to palpable lymph nodes identified incidentally in the neck, inguinal, and axillary regions. The extensive diagnostic work-up, including advanced imaging, revealed a pattern not commonly associated with diffuse large B-cell lymphoma (DLBCL), including hypermetabolic thickening in the posterior nasopharynx, significant hypermetabolism around the pancreas, and suspicious activity in the spleen and lung. Notably, the involvement extended to both parotid glands and a vast array of lymph nodes, marking an atypical presentation that underscores DLBCL's potential for widespread disease. Biopsies confirmed DLBCL with a non-germinal center phenotype, an aggressive variant with implications for treatment and prognosis. Despite a thorough diagnostic process, the patient elected to forgo the recommended DA-R-EPOCH chemotherapy, highlighting significant ethical and autonomy considerations within the realm of oncological care. This case contributes to the medical literature by illustrating the diagnostic challenges and treatment decision complexities in cases of DLBCL with unusual disease distribution and patient care preferences.