Cross-sectional evaluation of thoracic lymphoma

Thoracic Imaging Manifestations of Treated Lymphomas: Response Evaluation, Posttherapeutic Sequelae, and Complications

Lymphoma is the most common hematologic malignancy comprising a diverse group of neoplasms arising from multiple blood cell lineages. Any structure of the thorax may be involved at any stage of disease. Imaging has a central role in the initial staging, response assessment, and surveillance of lymphoma, and updated standardized assessment criteria are available to assist with imaging interpretation and reporting. Radiologists should be aware of the modern approaches to lymphoma treatment, the role of imaging in posttherapeutic surveillance, and manifestations of therapy-related complications.

[Lymphoma in children and adolescents]

CLINICAL/METHODOLOGICAL ISSUE

Lymphoma is the third most common neoplasm in children. Detection, accurate staging, and restaging are important for all radiologists involved in the diagnosis of children.

STANDARD RADIOLOGICAL METHODS

Magnetic resonance imaging (MRI), positron emission tomography/computed tomography (PET/CT), CT, ultrasound, X‑ray.

METHODOLOGICAL INNOVATIONS

Whole-body imaging (MRI and PET-MRI or PET-CT) play a key role in diagnostics and for therapy selection in Hodgkin lymphoma.

PERFORMANCE

In particular, hybrid imaging using ¹⁸F‑FDG PET is proving to be a powerful method for staging and restaging.

ACHIEVEMENTS

Standardization of imaging and inclusion in therapy studies (e.g. within the framework of the EuroNet-PHL-C2 study) improves diagnostics and simultaneously reduces therapy-related side effects.

PRACTICAL RECOMMENDATIONS

In Hodgkin lymphoma, deviations from the prescribed diagnostic procedure should be avoided. In clinically very heterogeneous non-Hodgkin lymphoma (NHL), on the other hand, the diagnostic procedure should be adapted to the actual clinical condition of the child. The role of interim PET in NHL is currently still the subject of clinical discussion.

Uncommon thoracic manifestations from extrapulmonary tumors: Computed tomography evaluation - Pictorial review

Although metastasis can occur at a variety of sites, pulmonary involvement is common in patients with cancer. Depending on the source and type of tumor, pulmonary metastases present with a wide range of radiologic appearances. Hematogenous dissemination through the pulmonary arteries to the pulmonary capillary network is the most common form of spread in pulmonary metastases. However, they may also reach the lung via lymphatic dissemination, secondary airway involvement, vessel tumor embolism, and direct chest invasion. In the evaluation of patients with known extrathoracic tumors, CT is the state-of-the-art imaging modality for detecting and characterize pulmonary metastases as well as to predict resectability. Although CT limitations are well known, knowledge of growth rates of various tumors and understanding the pattern of spread may be helpful clues in suggesting and even establish the specific diagnosis. The purpose of this pictorial review is to discuss the imaging appearances of different patterns of intrathoracic tumoral dissemination.

Multimodality imaging of cardiothoracic lymphoma

Lymphoma is the most common hematologic malignancy and represents approximately 5.3% of all cancers. The World Health Organization published a revised classification scheme in 2008 that groups lymphomas by cell type and molecular, cytogenetic, and phenotypic characteristics. Most lymphomas affect the thorax at some stage during the course of the disease. Affected structures within the chest may include the lungs, mediastinum, pleura, and chest wall, and lymphomas may originate from these sites as primary malignancies or secondarily involve these structures after arising from other intrathoracic or extrathoracic sources. Pulmonary lymphomas are classified into one of four types: primary pulmonary lymphoma, secondary pulmonary lymphoma, acquired immunodeficiency syndrome-related lymphoma, and post-transplantation lymphoproliferative disorders. Although pulmonary lymphomas may produce a myriad of diverse findings within the lungs, specific individual features or combinations of features can be used, in combination with secondary manifestations of the disease such as involvement of the mediastinum, pleura, and chest wall, to narrow the differential diagnosis. While findings of thoracic lymphoma may be evident on chest radiography, computed tomography has traditionally been the imaging modality used to evaluate the disease and effectively demonstrates the extent of intrathoracic involvement and the presence and extent of extrathoracic spread. However, additional modalities such as magnetic resonance imaging of the thorax and (18)F-FDG PET/CT have emerged in recent years and are complementary to CT in the evaluation of patients with lymphoma. Thoracic MRI is useful in assessing vascular, cardiac, and chest wall involvement, and PET/CT is more accurate in the overall staging of lymphoma than CT and can be used to evaluate treatment response.

Imaging of extranodal lymphoma with PET/CT

Hodgkin disease (HD) and non-Hodgkin lymphoma (NHL) represent a spectrum of malignant neoplasms arising from the lymphoid system with an incidence of around 8% of all malignancies. Although they are generally known as tumors of lymph nodes, 25% to 40% of HD/NHL tumors, especially NHL, arise at extranodal sites along the gastrointestinal tract, head and neck, orbit, central and peripheral nervous system, thorax, bone, skin, breast, testis, thyroid, and genitourinary tract. Extranodal involvement is an important pretreatment prognostic factor for patients with lymphoma and its incidence has increased in the past 2 decades. Imaging plays an important role in the noninvasive pretreatment assessment of patients with extranodal lymphoma. This involvement can be subtle and may be overlooked during computed tomography (CT). Positron emission tomography/CT (PET/CT) has evolved into an important imaging tool for evaluation of lymphomas, facilitating the detection of affected extranodal sites even when CT shows subtle or no obvious lesions. Familiarity with extranodal manifestations and suggestive PET/CT features in different sites is important for accurate evaluation of lymphoma. This article reviews the extranodal PET/CT imaging findings regarding HD and NHL.

Extranodal lymphoma from head to toe: part 2, the trunk and extremities

OBJECTIVE

Lymphoma can affect virtually every tissue in the body, producing a variety of imaging appearances. In this article, the extranodal manifestations of this disease in the trunk and extremities are illustrated and the imaging features that aid in the diagnosis are reviewed.

CONCLUSION

Knowledge of the imaging appearances of extranodal lymphoma can aid the differential diagnosis of mass lesions encountered in tissues throughout the body on different imaging modalities.

Mucosa-associated lymphoid tissue lymphoma: multimodality imaging and histopathologic correlation

OBJECTIVE

We will illustrate the imaging features of gastrointestinal and nongastrointestinal mucosa-associated lymphoid tissue (MALT) lymphoma and their correlation with histopathologic findings. The radiologic features to distinguish gastrointestinal MALT lymphoma from other types of lymphomas will also be described.

CONCLUSION

Differences in clinical behavior and management make it exceedingly important to differentiate MALT lymphoma from other types of lymphomas. Radiologic and histopathologic findings need to be taken into account before making a diagnosis and treatment plan.

Pediatric Hodgkin lymphoma presenting with pulmonary nodules and leukemoid reaction

An 8-year-old female presented with fever and severe pain in the hipbones and legs for 2(1/2) months. Investigations revealed a leukemoid reaction and bilateral diffuse nodular opacities on chest X-ray. Supraclavicular lymph node biopsy was diagnostic of Hodgkin lymphoma (HL), mixed cellularity. Both pulmonary nodules and leukemoid reaction being present in the same patient with HL has not been reported.