Nodal Hodgkin Lymphoma in Neck



Nodal Hodgkin Lymphoma in Neck


Christine M. Glastonbury, MBBS





Key Facts


Terminology



  • Hodgkin lymphoma (HL)


  • Characterized by presence of Reed-Sternberg cells


Imaging



  • Most HL patients present due to neck adenopathy


  • Single nodal group or contiguous groups


  • Mediastinal nodes frequently involved at presentation


  • Head and neck HL is rarely extranodal


  • CECT: Homogeneous solid nodal masses



    • Necrosis or calcification uncommon


  • CECT and FDG PET are basic staging modalities


  • FDG PET shows marked activity


  • Persistently positive PET during treatment has high sensitivity for prediction of relapse


  • FDG PET differentiates post-treatment inactive scar from residual tumor


Top Differential Diagnoses



  • Reactive lymph nodes


  • Nodal differentiated thyroid carcinoma


  • Nodal non-Hodgkin lymphoma


  • Nodal squamous cell carcinoma


Pathology



  • Neoplastic cells are Reed-Sternberg cells


  • Most of tumor bulk is reactive inflammatory cells


  • 95% classic HL; aggressive tumor


  • 5% nodular lymphocyte-predominant HL


Clinical Issues



  • Young adult with enlarging, painless neck mass


  • 40% have B symptoms: Fever, sweats, weight loss


  • HL is potentially curable


  • 5-year survival: Stages I-III (≥ 85%), stage IV (80%)







Figure 1 (Left) Axial CECT in a teen girl with palpable neck masses demonstrates bilateral adenopathy image, larger on left. Nodes are homogeneous and isodense to muscle without evidence of necrosis or calcifications. (Right) Coronal projection from FDG PET study in the same patient demonstrates marked nodal uptake in lower neck bilaterally image and in superior mediastinum image. PET study showed no evidence of infradiaphragmatic disease, although focal nodular lung disease was demonstrated (extranodal disease).






Figure 2 (Left) Axial CECT more inferiorly demonstrates multiple solid large nodal masses image. On both sides, nodes splay common carotid and internal jugular vein (IJV). The right IJV image is flattened also. (Right) Axial CECT at the cervicothoracic junction demonstrates further bilateral nodal masses image abutting the carotid sheaths, with supraclavicular nodes image also evident. This was nodular sclerosing HL and was determined to be stage IV. It was successfully treated with chemoradiation, without relapse at 4 years.



TERMINOLOGY


Abbreviations



  • Hodgkin lymphoma (HL)



    • Classical Hodgkin lymphoma (CHL)


    • Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL)


Synonyms



  • Hodgkin disease


Definitions



  • HL: Classical or nodular lymphocyte-predominant



    • Characterized by presence of Reed-Sternberg cells


IMAGING


General Features



  • Best diagnostic clue



    • Young patient with neck & mediastinal adenopathy


  • Location



    • HL most commonly cervical & mediastinal nodes



      • Internal jugular, spinal accessory, & transverse cervical nodal chains


      • Involves contiguous nodal groups


    • Rarely involves Waldeyer ring or other extranodal neck sites (< 1%)


  • Size



    • Variable nodal size: 2-10 cm


  • Morphology



    • Single nodal chain ± spread to contiguous chain


    • 60-80% present with neck/supraclavicular nodes



      • 30% with axillary adenopathy


    • 50-60% have mediastinal nodes at presentation


CT Findings



  • NECT



    • Homogeneous lobulated round masses


    • Nodes isodense to muscle


    • Calcification uncommon except after treatment


  • CECT



    • Variable enhancement


    • Necrosis may be seen as low-density center

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Sep 20, 2016 | Posted by in HEAD & NECK IMAGING | Comments Off on Nodal Hodgkin Lymphoma in Neck

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