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Nodal Non-Hodgkin Lymphoma in Neck
Patricia A. Hudgins, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            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 lymphoma (DLBCL)
                • Multiple other subtypes: B-cell lymphoblastic, small lymphocytic, follicular, mantle cell, MALT, Burkitt, extranodal NK/T cell
              • H&N NHL has multiple forms
                • Nodal, nonnodal lymphatic (tonsils, lingual lymphoid, adenoids), nonnodal extralymphatic (e.g., thyroid)

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              • Reporting Tips

                                                Selected References

                                                1. American Joint Committee on Cancer: AJCC Cancer Staging Manual. 7th ed. New York: Springer. 599-615, 2010
                                                2. Hagtvedt T et al: Diffusion-weighted MRI compared to FDG PET/CT for assessment of early treatment response in lymphoma. Acta Radiol. 56(2):152-8, 2015
                                                3. Heacock L et al: PET/MRI for the evaluation of patients with lymphoma: initial observations. AJR Am J Roentgenol. 204(4):842-8, 2015
                                                4. Mosavi F et al: Whole-body diffusion-weighted MRI and <sup>18</sup>F-FDG PET/CT can discriminate between different lymphoma subtypes. Clin Radiol. ePub, 2015
                                                5. Riva E et al: Current imaging follow-up of non-Hodgkin lymphoma exposes patients to significant radiation but does not detect asymptomatic relapses. Leuk Lymphoma. 1-4, 2015
                                                6. Shinya T et al: Dual-time-point F-18 FDG PET/CT for evaluation in patients with malignant lymphoma. Ann Nucl Med. 26(8):616-21, 2012
                                                7. van Ufford HM et al: Newly diagnosed lymphoma: initial results with whole-body T1-weighted, STIR, and diffusion-weighted MRI compared with 18F-FDG PET/CT. AJR Am J Roentgenol. 196(3):662-9, 2011
                                                8. Allen-Auerbach M et al: Measuring response with FDG-PET: methodological aspects. Oncologist. 14(4):369-77, 2009
                                                9. Clifford GM et al: Cancer risk in HIV-infected persons: influence of CD4(+) count. Future Oncol. 5(5):669-78, 2009
                                                10. Delbeke D et al: Expert opinions on positron emission tomography and computed tomography imaging in lymphoma. Oncologist. 14 Suppl 2:30-40, 2009
                                                11. Fueger BJ et al: Comparison of CT, PET, and PET/CT for staging of patients with indolent non-Hodgkin's lymphoma. Mol Imaging Biol. 11(4):269-74, 2009
                                                12. Harrison LC et al: Non-Hodgkin lymphoma response evaluation with MRI texture classification. J Exp Clin Cancer Res. 28:87, 2009
                                                13. Hua F et al: Non-Hodgkin's lymphoma of supraclavicular lymph nodes can mimic metastasis of breast cancer during chemotherapy on FDG PET/CT. Clin Nucl Med. 34(9):594-5, 2009
                                                14. Hunt BM et al: Sarcoidosis as a benign cause of lymphadenopathy in cancer patients. Am J Surg. 197(5):629-32; discussion 632, 2009
                                                15. Hutchings M et al: PET/CT for therapy response assessment in lymphoma. J Nucl Med. 50 Suppl 1:21S-30S, 2009
                                                16. Kasamon YL et al: Phase II study of risk-adapted therapy of newly diagnosed, aggressive non-Hodgkin lymphoma based on midtreatment FDG-PET scanning. Biol Blood Marrow Transplant. 15(2):242-8, 2009
                                                17. Keil S et al: RECIST and WHO criteria evaluation of cervical, thoracic and abdominal lymph nodes in patients with malignant lymphoma: manual versus semi-automated measurement on standard MDCT slices. Rofo. 181(9):888-95, 2009
                                                18. Ngeow JY et al: High SUV uptake on FDG-PET/CT predicts for an aggressive B-cell lymphoma in a prospective study of primary FDG-PET/CT staging in lymphoma. Ann Oncol. 20(9):1543-7, 2009
                                                19. Otero HJ et al: CT and PET/CT findings of T-cell lymphoma. AJR Am J Roentgenol. 193(2):349-58, 2009
                                                20. Papadopouli E et al: Cervical lymphadenopathy in childhood epidemiology and management. Pediatr Hematol Oncol. 26(6):454-60, 2009
                                                21. Pfeiffer J et al: Sonography-assisted cutting needle biopsy in the head and neck for the diagnosis of lymphoma: can it replace lymph node extirpation? Laryngoscope. 119(4):689-95, 2009
                                                22. Rossi M et al: Computed tomography-based tumor volume in non-Hodgkin lymphoma: clinical correlation and comparison with magnetic resonance imaging. J Comput Assist Tomogr. 33(4):641-9, 2009
                                                23. Rossi M et al: Response analysis of non-hodgkin lymphoma using magnetic resonance imaging-based volumes. J Comput Assist Tomogr. 33(3):466-74, 2009
                                                24. Yang DH et al: The combined evaluation of interim contrast-enhanced computerized tomography (CT) and FDG-PET/CT predicts the clinical outcomes and may impact on the therapeutic plans in patients with aggressive non-Hodgkin's lymphoma. Ann Hematol. 88(5):425-32, 2009
                                                25. Zeng W et al: Spectrum of FDG PET/CT findings in Burkitt lymphoma. Clin Nucl Med. 34(6):355-8, 2009
                                                26. Abramson SJ et al: Imaging of pediatric lymphomas. Radiol Clin North Am. 46(2):313-38, ix, 2008
                                                27. Aiken AH et al: Imaging Hodgkin and non-Hodgkin lymphoma in the head and neck. Radiol Clin North Am. 46(2):363-78, ix-x, 2008
                                                28. Hutchings M et al: PET/CT in the management of haematological malignancies. Eur J Haematol. 80(5):369-80, 2008
                                                29. Just PA et al: 18F-fluorodeoxyglucose positron emission tomography/computed tomography in AIDS-related Burkitt lymphoma. AIDS Patient Care STDS. 22(9):695-700, 2008
                                                30. Pelosi E et al: Role of whole-body [18F] fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) and conventional techniques in the staging of patients with Hodgkin and aggressive non Hodgkin lymphoma. Radiol Med. 113(4):578-90, 2008
                                                31. Choi JW et al: Peripheral T-cell lymphoma in the neck: CT findings of lymph node involvement. AJNR Am J Neuroradiol. 27(5):1079-82, 2006
                                                32. Stetler-Stevenson M: Flow cytometry in lymphoma diagnosis and prognosis: useful? Best Pract Res Clin Haematol. 16(4):583-97, 2003
                                                33. Nathu RM et al: Non-Hodgkin's lymphoma of the head and neck: a 30-year experience at the University of Florida. Head Neck. 21(3):247-54, 1999
                                                34. Ahuja A et al: The use of sonography in differentiating cervical lymphomatous lymph nodes from cervical metastatic lymph nodes. Clin Radiol. 51(3):186-90, 1996
                                                Related Anatomy
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                                                Related Differential Diagnoses
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                                                References
                                                Tables

                                                Tables

                                                KEY FACTS

                                                • Terminology

                                                  • Imaging

                                                    • Top Differential Diagnoses

                                                      • Pathology

                                                        • Clinical Issues

                                                          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 lymphoma (DLBCL)
                                                              • Multiple other subtypes: B-cell lymphoblastic, small lymphocytic, follicular, mantle cell, MALT, Burkitt, extranodal NK/T cell
                                                            • H&N NHL has multiple forms
                                                              • Nodal, nonnodal lymphatic (tonsils, lingual lymphoid, adenoids), nonnodal extralymphatic (e.g., thyroid)

                                                          IMAGING

                                                          • General Features

                                                            • CT Findings

                                                              • MR Findings

                                                                • Ultrasonographic Findings

                                                                  • Nuclear Medicine Findings

                                                                    • Imaging Recommendations

                                                                      DIFFERENTIAL DIAGNOSIS

                                                                        PATHOLOGY

                                                                        • General Features

                                                                          • Staging, Grading, & Classification

                                                                            • Gross Pathologic & Surgical Features

                                                                              • Microscopic Features

                                                                                CLINICAL ISSUES

                                                                                • Presentation

                                                                                  • Demographics

                                                                                    • Natural History & Prognosis

                                                                                      • Treatment

                                                                                        DIAGNOSTIC CHECKLIST

                                                                                        • Consider

                                                                                          • Image Interpretation Pearls

                                                                                            • Reporting Tips

                                                                                              Selected References

                                                                                              1. American Joint Committee on Cancer: AJCC Cancer Staging Manual. 7th ed. New York: Springer. 599-615, 2010
                                                                                              2. Hagtvedt T et al: Diffusion-weighted MRI compared to FDG PET/CT for assessment of early treatment response in lymphoma. Acta Radiol. 56(2):152-8, 2015
                                                                                              3. Heacock L et al: PET/MRI for the evaluation of patients with lymphoma: initial observations. AJR Am J Roentgenol. 204(4):842-8, 2015
                                                                                              4. Mosavi F et al: Whole-body diffusion-weighted MRI and <sup>18</sup>F-FDG PET/CT can discriminate between different lymphoma subtypes. Clin Radiol. ePub, 2015
                                                                                              5. Riva E et al: Current imaging follow-up of non-Hodgkin lymphoma exposes patients to significant radiation but does not detect asymptomatic relapses. Leuk Lymphoma. 1-4, 2015
                                                                                              6. Shinya T et al: Dual-time-point F-18 FDG PET/CT for evaluation in patients with malignant lymphoma. Ann Nucl Med. 26(8):616-21, 2012
                                                                                              7. van Ufford HM et al: Newly diagnosed lymphoma: initial results with whole-body T1-weighted, STIR, and diffusion-weighted MRI compared with 18F-FDG PET/CT. AJR Am J Roentgenol. 196(3):662-9, 2011
                                                                                              8. Allen-Auerbach M et al: Measuring response with FDG-PET: methodological aspects. Oncologist. 14(4):369-77, 2009
                                                                                              9. Clifford GM et al: Cancer risk in HIV-infected persons: influence of CD4(+) count. Future Oncol. 5(5):669-78, 2009
                                                                                              10. Delbeke D et al: Expert opinions on positron emission tomography and computed tomography imaging in lymphoma. Oncologist. 14 Suppl 2:30-40, 2009
                                                                                              11. Fueger BJ et al: Comparison of CT, PET, and PET/CT for staging of patients with indolent non-Hodgkin's lymphoma. Mol Imaging Biol. 11(4):269-74, 2009
                                                                                              12. Harrison LC et al: Non-Hodgkin lymphoma response evaluation with MRI texture classification. J Exp Clin Cancer Res. 28:87, 2009
                                                                                              13. Hua F et al: Non-Hodgkin's lymphoma of supraclavicular lymph nodes can mimic metastasis of breast cancer during chemotherapy on FDG PET/CT. Clin Nucl Med. 34(9):594-5, 2009
                                                                                              14. Hunt BM et al: Sarcoidosis as a benign cause of lymphadenopathy in cancer patients. Am J Surg. 197(5):629-32; discussion 632, 2009
                                                                                              15. Hutchings M et al: PET/CT for therapy response assessment in lymphoma. J Nucl Med. 50 Suppl 1:21S-30S, 2009
                                                                                              16. Kasamon YL et al: Phase II study of risk-adapted therapy of newly diagnosed, aggressive non-Hodgkin lymphoma based on midtreatment FDG-PET scanning. Biol Blood Marrow Transplant. 15(2):242-8, 2009
                                                                                              17. Keil S et al: RECIST and WHO criteria evaluation of cervical, thoracic and abdominal lymph nodes in patients with malignant lymphoma: manual versus semi-automated measurement on standard MDCT slices. Rofo. 181(9):888-95, 2009
                                                                                              18. Ngeow JY et al: High SUV uptake on FDG-PET/CT predicts for an aggressive B-cell lymphoma in a prospective study of primary FDG-PET/CT staging in lymphoma. Ann Oncol. 20(9):1543-7, 2009
                                                                                              19. Otero HJ et al: CT and PET/CT findings of T-cell lymphoma. AJR Am J Roentgenol. 193(2):349-58, 2009
                                                                                              20. Papadopouli E et al: Cervical lymphadenopathy in childhood epidemiology and management. Pediatr Hematol Oncol. 26(6):454-60, 2009
                                                                                              21. Pfeiffer J et al: Sonography-assisted cutting needle biopsy in the head and neck for the diagnosis of lymphoma: can it replace lymph node extirpation? Laryngoscope. 119(4):689-95, 2009
                                                                                              22. Rossi M et al: Computed tomography-based tumor volume in non-Hodgkin lymphoma: clinical correlation and comparison with magnetic resonance imaging. J Comput Assist Tomogr. 33(4):641-9, 2009
                                                                                              23. Rossi M et al: Response analysis of non-hodgkin lymphoma using magnetic resonance imaging-based volumes. J Comput Assist Tomogr. 33(3):466-74, 2009
                                                                                              24. Yang DH et al: The combined evaluation of interim contrast-enhanced computerized tomography (CT) and FDG-PET/CT predicts the clinical outcomes and may impact on the therapeutic plans in patients with aggressive non-Hodgkin's lymphoma. Ann Hematol. 88(5):425-32, 2009
                                                                                              25. Zeng W et al: Spectrum of FDG PET/CT findings in Burkitt lymphoma. Clin Nucl Med. 34(6):355-8, 2009
                                                                                              26. Abramson SJ et al: Imaging of pediatric lymphomas. Radiol Clin North Am. 46(2):313-38, ix, 2008
                                                                                              27. Aiken AH et al: Imaging Hodgkin and non-Hodgkin lymphoma in the head and neck. Radiol Clin North Am. 46(2):363-78, ix-x, 2008
                                                                                              28. Hutchings M et al: PET/CT in the management of haematological malignancies. Eur J Haematol. 80(5):369-80, 2008
                                                                                              29. Just PA et al: 18F-fluorodeoxyglucose positron emission tomography/computed tomography in AIDS-related Burkitt lymphoma. AIDS Patient Care STDS. 22(9):695-700, 2008
                                                                                              30. Pelosi E et al: Role of whole-body [18F] fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) and conventional techniques in the staging of patients with Hodgkin and aggressive non Hodgkin lymphoma. Radiol Med. 113(4):578-90, 2008
                                                                                              31. Choi JW et al: Peripheral T-cell lymphoma in the neck: CT findings of lymph node involvement. AJNR Am J Neuroradiol. 27(5):1079-82, 2006
                                                                                              32. Stetler-Stevenson M: Flow cytometry in lymphoma diagnosis and prognosis: useful? Best Pract Res Clin Haematol. 16(4):583-97, 2003
                                                                                              33. Nathu RM et al: Non-Hodgkin's lymphoma of the head and neck: a 30-year experience at the University of Florida. Head Neck. 21(3):247-54, 1999
                                                                                              34. Ahuja A et al: The use of sonography in differentiating cervical lymphomatous lymph nodes from cervical metastatic lymph nodes. Clin Radiol. 51(3):186-90, 1996