Presenting clinical features (what brings the patient to the doctor): At least 70-75% of patients present because they have noticed the painless development of lymphadenopathy (i.e. enlargement of lymph nodes), usually in their neck glands or armpits.
The child in the photograph represents a typical presenting picture, viz. a well looking individual with a large painless lump appearing over a few months in the neck, indeed two thirds of patient present in this way.
Approximately 5% of patients have groin lymph gland enlargement but the vast majority of patients have the disease predominantly in the lymph node regions above the diaphragm. In these patients, a majority will also be found to have disease in the chest - usually lymph node enlargement that is detectable on simple chest x-ray as widening of the central chest structure shadows.
When the patient presents late in the natural history of the disease, then he/she may have other symptoms such as fevers, night sweats and weight loss (the so-called 'B' symptoms as they denote a more advanced stage of disease); pruritus/generalised itching may also occur in these cases.