Hodgkin’s and Non-

Hodgkin’s
Lymphomas
• 4% cancer USA every year,
• 5 most common type of cancer
• 5 leading cause of cancer death.
• any region of the body.
• lymphadenopathy,
• focal or diffuse organ involvement
• generalized multi- organ involvement.
 Hodgkin’s disease
• incidence (HD) 4 per 100,000 year,
• New HD 7880 14% of lymphomas.
• HD bimodal
• young adulthood,
• over 50
• 1/3 have systemic symptoms, such as low-
grade fever, night sweats, weight loss, pruritus,
or fatigue.
• infectious mononucleosis 3X HD.
• 80% younger than 60 years with newly
diagnosed HD are likely to be cured.
• therapy staging.
• early abbreviated chemotherapy involved
field radiation therapy,
• advanced only longer course of
chemotherapy
• Stage B symptoms and bulky disease (>10
cm) prognostic factors.
• >80% HD lymphadenopathy above the
diaphragm
• anterior and middle mediastinal nodes
• with or without disease of the hila
• 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.
• Secondary parotid
involvement not
uncommon,
• primary
involvement is
rather rare
• Pulmonary involvement > HD than (NHL).
• Nodules (with or without cavitation), reticular nodular
infiltrate, ground glass opacities, or irregular consolidations
• atelectasis secondary to endobronchial or nodal
obstruction.
• hilar lymphadenopathy or mediastinal masses extending
into the adjacent lung.
• Pulmonary involvement without
associated mediastinal or hilar
lymphadenopathy unlikely
• recurrences in the lung may be seen
without associated lymphadenopathy.
• HD extranodal direct invasion
hematogenous dissemination.
• spleen,
• lung,
• liver
• bone marrow.
• splenomegaly alone =
?¿
• splenomegaly + other
sites splenic lymphoma
involvement likely.
• 1/3 splenic involvement
have normal size
spleen, 1/3
splenomegaly, the
spleen is not involved
by tumor.
• HD in kidneys or (GI) tract rare.
• Primary bone lesions are rare,but
marrow involvement advanced
• calcifications after treatment.
• before treatment aggressive disease
 Non-Hodgkin’s
lymphoma
• NHL is a heterogenous B- cell or T-cell
origin.
• NHL 2 fastest growing cancer most
commonly occurring hematologic
cancer.
• incidence > 50% 15 years ?.
• 4% of all cancer deaths.
• NHL worse prognosis than HD.
• HD, spreads contiguous groups of
lymph nodes,
• NHL extranodal sites of disease.
• NHL classified by morphology and
histology.
• (REAL) immunophenotypic, genetic,
and clinical characteristics.
• modified (WHO)
 Most common west
• Diffuse large B-cell lymphoma 31%
• 􏰀 Follicular lymphoma 22%
• 􏰀 Small lymphocytic lymphoma 6%
• 􏰀 Mantle cell lymphoma 6%
• 􏰀 Peripheral T cell lymphoma 6%
• 􏰀 Extranodal marginal zone B-cell lymphoma
of MALT type 5%
• 􏰀 Others (including composite lymphomas)
24%
• Burkitt’s Epstein-Barr virus,
• MALT lymphoma Helicobacter pylori
• primary effusion lymphoma human
herpes virus 8 Kaposi’s sarcoma.
• t (11;14) for mantle cell lymphoma and
transloca- tion t (14;18) for follicular
lymphoma [1].
• NHL 2 groups:
• indolent lymphomas, slowly and have
fewer symptoms (eg, follicular
lymphoma, MALT),
• aggressive lymphomas, (eg, diffuse
large cell lymphoma, Burkitt’s
lymphoma, Mantle cell lymphoma).
• Extranodal disease and marrow
>NHL than HD.
• Extranodal lymphatic tissue
• Waldeyer’s ring
• spleen
• nonlymphatic organs like
• liver,
• GI tract
• lung,
• bone,
• CNS
• Parotid and thyroid gland breast, bones, testes, or
leptomeninges
• primary effusion lymphoma/body cavity lymphoma,
enteropathy-type T-cell lymphoma, or MALT lymphoma
might present with localized
• Pulmonary pleural
disease may be
seen without
mediastinal
involvement.
• Solid pleural masses
are infrequent
• Isolated chest wall
soft tissue masses
rare
• liver or spleen
involvement
• focal lesions
• similar to
metastatic
disease.
• Diffuse involvement of liver and spleen
is more difficult to detect.
• Enlargement of the liver is suggestive of
infiltration.
• Enlargement of the
spleen is not a
reliable predictor of
disease,
• enlargement + other
sites of involvement
• Small bowel, stomach, or colon often
are involved with NHL multicentric.
• The stomach is the most commonly
involved
• Secondary
involvement of the
pancreas also is
seen often in
patients who have
NHL
 Renal
• solid masses
• diffuse infiltrations
with
nephromegaly,
• or by invasion of
retroperitoneal
disease
• The genitourinary
tract rare
 Retroperitoneal and
mesenteric disease

• enlarged
lymph nodes
• mimicking peritoneal carcinomatosis,
• conglomerate
masses
Immunocompromised
• Extra- nodal sites
• GI tract,
• [CNS]
• liver
• bone marrow
• lung
 Central nervous
system lymphoma
• Most primary CNS lymphomas are
NHL.
• 1% of all lymphomas 16% of all primary
brain tumors.
• HIV congenital ,IgA deficiency and
immunosuppressive therapy
 immunocompetent
• solitary, supratentorial
lesion with homo-
geneous enhancement.
• cross the corpus
callosum in a butterfly
pattern.
• Highly packed abnormal
cells
• density of these
lesions in unenhanced
CT
• hypointense signal
intensity on T2
immunocompromised
• multiple lesions
irregular margins,
heterogeneity,
and ring
enhancement.
• vs cerebral
toxoplasmosis.
• Primary leptomeningeal lymphoma
discrete masses or faint enhancement.
• Leptomeningeal lymphoma + solitary
intracerebral lesions;
Childhood lymphoma
• 1700 annually
• NHL > HD.
• NHL<15y> HD
• NHL
• GI tract,
• solid abdominal viscera pancreas and kidneys
• extranodal sites in the head and neck.
• Burkitt’s lymphoma, large cell lymphoma and T-cell lym-
phoma are the most common.
• Burkitt’s lymphoma includes an
• abdominal mass (70%),
• enlarged nodes in neck or pharynx (25%),
• pleural effusion (22%),
• bone involvement (10%), and
• mediastinal or hilar nodes (7%).
• Intussusception in teenagers or children with
Burkitt’s lymphoma is not an uncommon
presentation.
• T-cell lymphoma
commonly
involves the
thymus
• T-cell lymphoma
and T-cell
leukemia
• degree of bone
marrow
involvement
• similar
radiographic
features.
 Staging

• Accurate staging allows minimization of

toxic therapies
• decreas- ing the risk of secondary
malignancies, 10%
• Ann Arbor HD and NHL.
• Clinical staging of NHL in children is
less important
• all considered disseminated disease,
• even if the radiologic findings suggest
localized disease.
• lymph node involvement,
• PET/CT and contrast- enhanced CT
had sensitivities of 98% and 88%
• specificities of 100% and 86%,
respectively [50].
 Assessment of
treatment response
• Measure the longest axial diameter by
the largest perpendicular diameter
• Diffuse, illdefined lesions
• perirenal infiltration in NHL
• Pulmonary lymphatic spread
• are not measurable, but should be
described
• A complete response in NHL requires
that all involved lymph nodes return to
normal size,
• might not be achieved in all lymph
nodes because of fibrosis or necrosis.
• FDG-PET is superior to CT in
differentiation of viable tumor, necrosis,
and fibrosis.
• For predictably PET-avid histologies
• diffuse large B-cell NHL,
• Hodgkin’s lymphoma
• follicular
• mantle cell lymphoma
• PET pretreatment is encouraged
strongly
• response after
completion of
therapy,
• residual masses,
• tumor persistence
?
 SUV

• 13 indicates a high likelihood of

aggressive histology
• SUV of no more than 6 indolent
histology.