Roentgenographic changes in childhood Hodgkin's disease

Lymphography in Childhood Cancer

Lymphographic investigations were done in 139 children (84 males and 55 females). Up to the age of 10 years the examination was performed in anesthesia; after that age suitable sedation only was given. The radiographic pattern of the lymph node involvement in this type of tumor is the same in children as in adults. Peculiar patterns were observed in neuroblastoma and in Ewing's sarcoma. 78 patients (57.4%) were suffering from systemic disease and 59 (41.9%) from solid tumors; in 2 cases the clinical diagnosis of tumor was not borne out by the histologic findings. In 35.3% of the cases with Hodgkin's disease and in 29% of supradiaphragmatic reticuloendothelial sarcoma lymphography revealed subdiaphragmatic lymph node involvement. In the stage III and IV patients lymphography was always pathologic. Pathologic lymph nodes were found in 3/10 patients with lymphoma arising in Waldeyer's tonsillar ring. Metastases were present in 40/59 of the cases of solid tumor (68.9%); the incidence of metastases was especially high in neuroblastoma (20/24), in rhabdomyosarcoma (4/5) and in tumors of the gonades (7/9). 16 cases were operated on; 2 false positives were found for lymph nodes in which there was pronounced reactive inflammatory hyperplasia.

Computerised tomography in the staging of Hodgkin's disease and non-Hodgkin's lymphoma

The last 25 years have seen major changes in the imaging investigation and subsequent management of patients with Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL); accurate staging is vital for prognostication and treatment in both, and particularly in HD. The choice of imaging modality for staging depends on its accuracy, impact on clinical decision-making, and availability. Modern CT scanners fulfil most of the desired criteria. The advent of CT scanning, along with the development of ever more effective chemotherapeutic regimens, has resulted in the virtual demise of bipedal lymphangiography (LAG) as a staging tool in patients with lymphoma. It has rendered superfluous a battery of other tests that were in routine use. This contribution reviews the evidence for the use of CT in preference to LAG. CT accurately depicts nodal enlargement above and below the diaphragm, has variable sensitivity for intra-abdominal visceral involvement and is generally outstanding in depicting the extent of disease, especially extranodal extension. Despite the advances in CT technology, there are still areas where CT performs less well (e.g. disease in normal-sized lymph nodes, splenic and bone marrow infiltration). The influence of technical factors, such as the use of intravenous contrast medium, is discussed. In some instances, CT is not the imaging modality of choice and the place of newer techniques such as MRI and endoscopic ultrasound will be reviewed.

Hodgkin's disease in children: involvement of lung and pleura

In 160 children with Hodgkin's disease, lung involvement was studied. In 14.4%, lung lesions were diagnosed at the first admission and an additional 7.5% of the patients developed lung lesions in the course of the disease. As a rule lung involvement was observed in advanced disease. It has been stated that there is no particular difference in the response to treatment in any particular type of lesion, spread either by contiguity of dissemination. Of all methods of treatment, combination chemotherapy (MOPP programme) showed the best results. In our series of children it was not possible to show any advantage to favour irradiation as against combination chemotherapy in the treatment of lung lesions.

Pediatric Hodgkin's disease. I. Radiographic evaluation

The pretreatment roentgenographic evaluation of 105 consecutive patients less than 16 years of age with Hodgkin's disease was reviewed. The patients were divided into groups aged 1-10 years (37%) and 11-15 years (63%). All patients had chest roentgenograms, of which 36% were abnormal in the younger group and 77% abnormal in the older group. Full-lung tomography was helpful only when the chest film was abnormal or equivocal. Foot lymphography was performed in 103 patients with 20% positive for Hodgkin's disease. Lymphographic-histologic correlation was 98% in the 62 patients undergoing laparotomy. Routine skeletal surveys, as well as examinations of the urinary tract and gastrointestinal tract, were not rewarding.

Hodgkin's disease in children: clinico-roentgenologic features of the lesion in the chest

The roentgenologic features of Hodgkin's disease were studied in 105 patients under 14 years of age. The mediastinal and hilar nodes were involved in 64.7% of patients. Some consistency of extent and pattern of disease was observed in that mediastinal lymphatic lesions could be associated with cervico-supra-clavicular and retroperitoneal lesions. There was lung infiltration in 14.3% of patients and the frequency of this lesion dependent on the histological type. It was commoner in nodular sclerosis, mixed cellularity and lymphocytic depletion. Lung infiltration usually developed in continuity with the lymphatic gland lesion and only rarely in a metastasis-like form.