04 - Radiol Clin N Am 2007 - Hodgkin's and Non-Hodgkin's Lymphomas

15 Pages·2007·1.51 MB·English

Hodgkin’s and Non-Hodgkin’s
Lymphomas

Ju¨rgen Rademaker, MD

Lymphomas represent about 4% of the new cases
of cancer diagnosed in the United States every year,
making them the fifth most common type of cancer
and the fifth leading cause of cancer death.
Lymphoma can affect any region of the body.
Most patients present with lymphadenopathy, focal
or diffuse organ involvement, or generalized multi-
organ involvement.

Clinical and radiologic features

Hodgkin’s disease

The incidence of Hodgkin’s disease (HD) is about 4
per 100,000 persons per year, and accounts for less
than 1% of all cancers worldwide. New cases of HD
in the United States were estimated at 7880 and
accounted for 14% of lymphomas [1–3]. HD has
a bimodal
incidence
curve and
occurs
more
frequently in two separate age groups, the first being
young adulthood, the second being in those over
50 years old. About one third of people with HD
have systemic symptoms, such as low-grade fever,
night sweats, weight loss, pruritus, or fatigue [4].
People with a history of infectious mononucleosis
have a threefold increased likelihood of developing
HD.

During the past 20 years, advances in radiation
and chemotherapy increased the cure rate, and
now more than 80% of all patients younger than
60 years with newly diagnosed HD are likely to be
cured [5]. Selection of the appropriate therapy is
based on accurate staging. Patients with early stage
disease are treated with abbreviated courses of
chemotherapy followed by involved field radiation
therapy, whereas those with advanced-stage disease
receive a longer course of chemotherapy without
radiation therapy. Stage B symptoms and bulky
disease (>10 cm) remain the most important prog-
nostic factors in HD.
More than 80% of patients who have HD present
with lymphadenopathy above the diaphragm that
commonly involves anterior and middle mediasti-
nal nodes with or without disease of the hila
(Figs. 1 and 2) [6]. Large mediastinal masses may
invade the chest wall and pericardium directly.
Hilar adenopathy is uncommon without detectable
mediastinal disease. Pleural effusions are often
caused by lymphatic or venous obstruction. Sec-
ondary involvement of the thyroid or parotid gland
is not uncommon, whereas primary involvement is
rather rare (Fig. 3).
Pulmonary involvement is found more often in
HD than in non-Hodgkin’s lymphoma (NHL).

R A D I O L O G I C
C L I N I C S
O F N O R T H A M E R I C A

Radiol Clin N Am 45 (2007) 69–83

Department of Radiology, Memorial Sloan-Kettering Cancer Center, Cornell University, Weill Medical
College, 1275 York Avenue, New York, NY 10021, USA
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