Text Book Reading David Sutton

Radiology and Imaging 7th

ed vol.1

Section 2, page 521

LYMPHOMA

Presentan : Reni Indrastuti

Konsulen : dr. Yana Supriatna, PhD., Sp.Rad

INTRODUCTION

• Defnition

- primary neoplasms of the immune system and arise within lymphoid

tissue (Neumann et al 1985).

- a heterogenous group of diseases caused by malignant

lymphocytes which accumulate in lymph nodes and cause the

characteristic lymphadenopathy.

• Epidemiology

- approximately 4% of the newly diagnosed malignant tumours in the

UK.

- In chilldren, the third most frequent malignancy, following behind

leukaemia and central nervous cystem neoplasia

- males > females

- Incidence : NHL increasing, Hodgkin lymphoma stable

- Sheira, G. 2006 - Lee david, MD

- Sutton, D., Radiology and imaging 7th ed

PREDISPOSING

DISEASE

1- HTLV-1 ( Human T-cell lymphoma/leukaemia virus) is causative

agent in T-cell leukaemia/lymphoma.

2- Immunodeficiency, acquired or inherited, predispose to B-cell

lymphoma.

3- EBV, underlies the endemic form of Burkitt s lymphoma.

4- Helicobacter pylori has been implicated as a predisposing factor

in MALT lymphoma( mucosa associated lymphoid tissue).

5- Hepatitis C virus has been suggested as a risk factor for the

development of NHL.

- Sheira, G. 2006

CLINICAL

MANIFESTATION

• Variable• severity: asymptomatic to extremely ill

• time course: evolution over weeks, months, or years

• Systemic manifestations• fever, night sweats (HL>NHL), weight loss, anorexia,

pruritis (HL>NHL), LBP

• Local manifestations• lymphadenopathy, splenomegaly most common

• any tissue potentially can be infiltrated

• Lymph node swelling, often in the upper body area but it can be

in almost any node or related organ. The node is usually NOT

painful (HL, NHL)- Covell, Bruce Dr

Lymphoma classification

(2001 WHO)

• B-cell neoplasms

– precursor

– mature

• T-cell & NK-cell neoplasms

– precursor

– mature

• Hodgkin lymphoma

Non-

Hodgkin

Lymphomas

60%

40%

- Lee, David., MD

DIAGNOSIS

• Diagnosis should be biopsy-proven before treatment

is initiated

• Need enough tissue to assess cells and architecture

– open bx vs core needle bx vs FNA

• This has a large impact on radiology, with imaging being used

over large periods of time to finesse management

- This is particularly important in the case of Hodgkin's disease where 15-20

years after treatment the cumulative mortality from the complications of

treatment is greater than the disease itself.

- important to reduce the complications of all stages of management including

radiology

- Sheira, G. 2006

- Sutton, D., Radiology and imaging 7th ed

STAGING

Unlike HL, NHL is frequently wide spread at the time of diagnosis (stage

III, IV), often involving lymph nodes and extranodal sites such as GIT.

IMAGING MODALITY

CT SCAN

• Staging

• Follow up

FDG-PET

• Staging

• Follow up

MRI

• Staging

• Follow up

USG

• Initial diagnosis for organs involvement

• Guided biopsy

J Ultrasound Med 2007; 26:791–796

ORGANS INVOLVEMENT

Liver Spleen Kidney

Adrenal

glands

Pancreas Stomach

Small bowel

and

mesentery

Colon

A. Canelas, ESGAR Congress 2008

Sonographics Findings

Sonogram of the liver showing round, well-

defined hypoechoic focal lesions of 20 mm

in maximal diameter

A hypoechoic ring is clearly visible in

the periphery of a liver lesion.

Fine-needle aspiration biopsy confirmed the diagnosis of infiltration of the liver by a diffuse large B-cell lymphoma.

J Ultrasound Med 2007; 26:791–796

Sonographics Findings

Single focal liver lesion with the sonographic appearance of a cyst with

echogenic content, as seen in axial (left) and longitudinal (right) scans.

Echinococcal disease was suspected. Nevertheless, FNAB showed liver

infiltration by non-Hodgkin lymphoma.

J Ultrasound Med 2007; 26:791–796

Sonographics Findings

Target lesion corresponding to a

patient with infiltration

of the liver by a diffuse large B-

cell lymphoma

J Ultrasound Med 2007; 26:791–796

RESUME

INTRODUCTION CLASSIFICATION

CLNICAL

MANIFESTATION

DIAGNOSIS STAGING

IMAGING

MODALITY

ORGANS

INVOLVEMENT

SONOGRAPHIC

FINDINGS

QUIZ

Sonography was performed for 54

years old man with nonspecific liver

biochemical anomalies.

a. Please describe the

sonographics findings !

b. What are the differential

diagnosis could be taken?

TERIMAKASIH DAN MOHON ASUPAN

“Many realities hidden behind wall

of perception.”