159 Neoplastic Lymphadenopathy: Hodgkin Lymphoma

CASE 159


image Clinical Presentation


26-year-old man with chest discomfort


image Radiologic Findings


PA (Fig. 159.1) and lateral (Fig. 159.2) chest radiographs demonstrate a large lobular anterior mediastinal mass that extends to both sides of midline, but predominantly to the right. Contrast-enhanced chest CT (mediastinal window) (Figs. 159.3, 159.4) reveals a large mediastinal soft-tissue mass of irregular lobular borders, which occupies the anterior mediastinum; encases the left brachiocephalic vein, superior vena cava, and ascending aorta; partially encases the right upper lobe bronchus; and produces an irregular margin with the adjacent right upper lobe. Note associated right paratracheal lymphadenopathy (Fig. 159.3).


image Diagnosis


Hodgkin Lymphoma


image Differential Diagnosis


• Non-Hodgkin Lymphoma


• Metastatic Mediastinal Lymphadenopathy; Lung Cancer, Extrathoracic Malignancy


• Thymoma, Invasive


• Thymic Malignancy



image


Fig. 159.1



image


Fig. 159.2




image


Fig. 159.3



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Fig. 159.4


image Discussion


Background


The lymphomas are a heterogeneous group of malignant neoplasms of the cells of the immune system characterized by proliferation and enlargement of lymph nodes and secondary lymphoid tissues. Non-Hodgkin lymphoma is the most frequent lymphoma and accounts for approximately 75% of cases, while Hodgkin lymphoma accounts for approximately 25% of lymphomas. However, mediastinal involvement by lymphoma is much more common in patients Hodgkin lymphoma than in those with non-Hodgkin lymphoma. The most common cell type of mediastinal Hodgkin lymphoma is nodular sclerosis. The most common mediastinal non-Hodgkin lymphoma is diffuse large B-cell lymphoma (which, together with follicular lymphoma, accounts for over 50% of all non-Hodgkin lymphomas), although lymphoblastic lymphoma and adult T-cell lymphoma characteristically manifest as large mediastinal masses. The latest WHO classification of lymphoma is complex and consists of over 20 subtypes based on cell of origin (B or T cell), morphologic features, and immunophenotypic characteristics.


Etiology


The etiology of lymphoma is unknown. The increasing incidence of non-Hodgkin lymphoma has been in part attributed to the growing elderly population and the HIV epidemic. Various forms of immunosuppression have been linked to extranodal lymphoma.


Clinical Findings


Hodgkin Lymphoma

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Jan 14, 2016 | Posted by in RESPIRATORY IMAGING | Comments Off on 159 Neoplastic Lymphadenopathy: Hodgkin Lymphoma

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