Nodal Non-Hodgkin Lymphoma in Neck



Nodal Non-Hodgkin Lymphoma in Neck


Patricia A. Hudgins, MD









Figure 1 (Left) Axial CECT shows multiple large, round, solid lymph nodes in every chain of the suprahyoid neck. Bilateral nodes are evident in levels IIA image, IIB image, and IB image. Absence of necrosis with such large nodes suggests that these are not metastases from H&N squamous cell carcinoma. (Right) Axial CECT in a different patient shows nodal and tonsillar lymphoma. Level II nodal mass is partially necrotic image, with extranodal infiltration of fat and paraspinal muscles. Right tonsil is homogeneously enlarged image.






Figure 2 (Left) Axial CECT demonstrates massive left nodal conglomerate, some with necrosis image. Surrounding induration and stranding of fat in left neck suggests inflammatory response. Other large nonnecrotic nodes image are seen bilaterally. (Right) Axial T2WI FS MR reveals multiple heterogeneous and predominantly hyperintense nodal masses image. Despite large size, nodes insinuate around structures with little mass effect and no arterial compression. Largest node wraps around anterior scalene muscle image.



TERMINOLOGY


Abbreviations



  • Non-Hodgkin lymphoma (NHL)


Definitions



  • NHL is lymphoreticular system malignancy, thought to arise from lymphocytes & derivatives


  • Multiple different NHL subtypes



    • Most common (> 30%): Diffuse large B cell (DLBCL)


  • Head & neck NHL has multiple forms



    • Nodal, non-nodal lymphatic (tonsils & adenoids), non-nodal extralymphatic (e.g., thyroid)


IMAGING


General Features



  • Best diagnostic clue



    • Multiple bilateral, enlarged nodes involving multiple nodal chains


  • Location



    • All cervical nodal chains may be involved


    • Levels II, III, & IV often involved


    • Superficial adenopathy, spinal accessory (level V) nodes common


  • Size



    • Different patterns of nodes



      • Multiple mildly enlarged, 1-3 cm nodes


      • Dominant node 3-5 cm in size; may be ≤ 10 cm


  • Morphology



    • Round or oval enlarged nodes, typically solid


    • Nodal necrosis ± extranodal tumor spread suggests aggressive NHL



      • AIDS-associated NHL often aggressive: Necrosis and surrounding induration


CT Findings

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