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Bae S, Choi YS, Sohn B, Ahn SS, Lee SK, Yang J, Kim J. Squamous Cell Carcinoma and Lymphoma of the Oropharynx: Differentiation Using a Radiomics Approach. Yonsei Med J 2020; 61:895-900. [PMID: 32975065 PMCID: PMC7515782 DOI: 10.3349/ymj.2020.61.10.895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/31/2020] [Accepted: 08/17/2020] [Indexed: 02/08/2023] Open
Abstract
The purpose of this study was to evaluate the diagnostic performance of magnetic resonance (MR) radiomics-based machine learning algorithms in differentiating squamous cell carcinoma (SCC) from lymphoma in the oropharynx. MR images from 87 patients with oropharyngeal SCC (n=68) and lymphoma (n=19) were reviewed retrospectively. Tumors were semi-automatically segmented on contrast-enhanced T1-weighted images registered to T2-weighted images, and radiomic features (n=202) were extracted from contrast-enhanced T1- and T2-weighted images. The radiomics classifier was built using elastic-net regularized generalized linear model analyses with nested five-fold cross-validation. The diagnostic abilities of the radiomics classifier and visual assessment by two head and neck radiologists were evaluated using receiver operating characteristic (ROC) analyses for distinguishing SCC from lymphoma. Nineteen radiomics features were selected at least twice during the five-fold cross-validation. The mean area under the ROC curve (AUC) of the radiomics classifier was 0.750 [95% confidence interval (CI), 0.613-0.887], with a sensitivity of 84.2%, specificity of 60.3%, and an accuracy of 65.5%. Two human readers yielded AUCs of 0.613 (95% CI, 0.467-0.759) and 0.663 (95% CI, 0.531-0.795), respectively. The radiomics-based machine learning model can be useful for differentiating SCC from lymphoma of the oropharynx.
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Affiliation(s)
- Sohi Bae
- Department of Radiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Yoon Seong Choi
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Beomseok Sohn
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Soo Ahn
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Koo Lee
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jaemoon Yang
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jinna Kim
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
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Batta N, Shukla M, Pandey M. Natural course of diffuse large B cell lymphoma-a manifestation in buccal mucosa. World J Surg Oncol 2019; 17:219. [PMID: 31842892 PMCID: PMC6916459 DOI: 10.1186/s12957-019-1766-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 12/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transformation and progression of lymphoma after treatment is well known; however, since the advent of chemotherapy and radiotherapy, progression in untreated lymphoma is seldom seen. We present a case which was misdiagnosed and treated as abdominal tuberculosis later presented with progression and involvement of oral cavity. CASE PRESENTATION A 41-year-old male who presented with urinary symptoms and abdominal pain was diagnosed as abdominal tuberculosis and treated. Two years later, he presented with B symptoms and oral cavity lesion that was diagnosed as diffuse large B cell lymphoma. The patient was treated with R-CHOP chemotherapy with complete regression of the lesion. CONCLUSION Involvement of extranodal sites in predominantly nodal disease does occur; however, involvement of oral cavity is rare. Though primary extranodal lymphoma is reported to occur in oral cavity and oropharynx, natural progression in untreated disease is seldom documented.
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Affiliation(s)
- Nishant Batta
- Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India.,SRL Diagnostics, Lanka, Varanasi, India
| | - Mridula Shukla
- Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India.,SRL Diagnostics, Lanka, Varanasi, India
| | - Manoj Pandey
- Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India. .,SRL Diagnostics, Lanka, Varanasi, India.
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A Case Report of Diffuse Large B-cell Lymphoma Masquerading as Necrotizing Lymph Nodes: The Role of Core Needle Biopsy for Early Diagnosis. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2018. [DOI: 10.5812/ijcm.9571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Abstract
Malignancies in the maxillofacial region are rare but comprise a broad spectrum of lesions. Given the potential for malignancies to mimic dental/sinus/temporomandibular joint pathology or remain asymptomatic, the judicious radiologist will be familiar with the initial and unique malignant changes affecting the dentition, periodontium, and supporting osseous structures on conventional film, dental, and sinus imaging. This article is meant to serve as a complement to the many excellent texts dedicated to advanced imaging techniques for the staging of known malignancies. The lesions discussed are a representative sample of malignancies involving hard tissues of the maxillofacial complex but are far from complete.
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Watal P, Bathla G, Thaker S, Sato TS, Moritani T, Smoker WRK. Multimodality Imaging Spectrum of the Extranodal Lymphomas in the Head and Neck-A Pictorial Review. Curr Probl Diagn Radiol 2017; 47:340-352. [PMID: 29174137 DOI: 10.1067/j.cpradiol.2017.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/14/2017] [Accepted: 07/26/2017] [Indexed: 02/06/2023]
Abstract
Lymphoma is the second most common malignant neoplasm of the head and neck region, involving the nodal and/or extranodal sites or both in a variable fashion. Lymphoma may mimic a variety of tumors in this region depending on the subsite involved. The usual presentation of lymphomatous disease is presence of multiple enlarged, often conglomerate, lymph nodes without significant necrosis. Extranodal lymphomas demonstrate more complex radiologic features, but careful evaluation can identify distinct imaging patterns to suggest extranodal lymphomatous disease from other more common lesions. Knowledge of these imaging features can help raise suspicion for lymphoma as a differential consideration. This can be of critical importance since further work-up and management can be vastly different between lymphomatous disease and other disease entities. The authors present a pictorial review of the spectrum of imaging findings in extranodal head and neck lymphomas.
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Affiliation(s)
- Pankaj Watal
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA.
| | - Girish Bathla
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Siddharth Thaker
- Department of Radiology, M P Shah Government Medical College & Government General Hospital, Jamnagar, Gujarat, India
| | - T Shawn Sato
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Toshio Moritani
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Wendy R K Smoker
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA
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Abstract
Lymphadenopathy is a common clinical finding in a patient seeking oral health care. It may be in a localized, limited, or generalized form. Malignancies, infections, autoimmune disorders, iatrogenic, and other miscellaneous conditions are considered as the causes for cervical lymphadenopathy. Unexplained cervical lymphadenopathy is a cause of concern for physician and patient because sometimes it could be the manifestation of an underlying malignancy. However, a methodological approach to lymphadenopathy can disclose the accurate diagnosis causing minimal discomfort for the patient and in a short time. This paper reports the significance of cervical lymph node examination and ensuing investigations, which led to a diagnosis of non-Hodgkins lymphoma.
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Affiliation(s)
- Athira Aruna Ramadas
- Department of Oral Medicine and Radiology, Amrita School of Dentistry, Kochi, Kerala, India
| | - Renju Jose
- Department of Oral Medicine and Radiology, Amrita School of Dentistry, Kochi, Kerala, India
| | - Beena Varma
- Department of Oral Medicine and Radiology, Amrita School of Dentistry, Kochi, Kerala, India
| | - Marina Lazar Chandy
- Department of Oral Medicine and Radiology, Amrita School of Dentistry, Kochi, Kerala, India
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James SLJ, Cozens NJA, Robinson IA. Skeletal Muscle Involvement in Six Cases of Non-Hodgkin's Lymphoma of the Head and Neck Region. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2016. [DOI: 10.1179/174313405x59990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Extra-nodal involvement of non-Hodgkin's lymphoma (NHL) is well described. Skeletal muscle involvement is rare with the muscles of the extremities being most commonly affected. We present a series of six patients that have attended our Joint Head and Neck Ultrasound and Cytopathology clinic. In these cases, skeletal muscle involvement by NHL was demonstrated in the head and neck region. The ultrasound findings in these cases are presented and discussed.
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Hong B, Petrosyan V, Kruger AR. Unusual Presentation of Epstein-Barr Virus-Positive Diffuse Large B-Cell Non-Hodgkin Lymphoma of the Elderly. J Oral Maxillofac Surg 2016; 74:1180.e1-7. [PMID: 26850867 DOI: 10.1016/j.joms.2016.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 01/04/2016] [Accepted: 01/04/2016] [Indexed: 02/07/2023]
Abstract
This report describes the case of a 76-year-old woman diagnosed with Epstein-Barr virus-positive diffuse large B-cell non-Hodgkin lymphoma of the elderly. She had an unusual presentation of the disease with widespread skeletal muscle, masticatory muscle, and parotid gland involvement and the development of interesting erythematous lesions in the neck during chemotherapy. One month after completion of chemotherapy, positron-emission tomography (PET) showed features of persistent lymphoma, but a repeat PET scan a month later showed no active disease. This case reiterates 2 important points: first, to consider lymphoma a differential diagnosis in masticatory muscle enlargement and second, to question false positivity when interpreting post-treatment PET scan results, especially in the absence of clinical disease.
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Affiliation(s)
- Bosun Hong
- Senior House Officer, Department of Oral and Maxillofacial Surgery, Royal Cornwall Hospital, Truro, UK.
| | - Vahe Petrosyan
- Medical Student, University of Birmingham, Birmingham; Trust Grade, Department of Oral and Maxillofacial Surgery, Queens Medical Centre, Nottingham; Locum Staff Grade, Department of Oral and Maxillofacial Surgery, Northampton General Hospital, Northampton, UK
| | - Anton R Kruger
- Consultant Hematologist, Department of Hematology, Royal Cornwall Hospital, Truro, UK
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Spectrum of Physiologic and Pathologic Skeletal Muscle18F-FDG Uptake on PET/CT. AJR Am J Roentgenol 2015; 205:W141-9. [DOI: 10.2214/ajr.14.13457] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Zhu L, Wang P, Yang J, Yu Q. Non-Hodgkin lymphoma involving the parotid gland: CT and MR imaging findings. Dentomaxillofac Radiol 2013; 42:20130046. [PMID: 23975113 DOI: 10.1259/dmfr.20130046] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES As an uncommon neoplasm, parotid non-Hodgkin lymphoma (NHL) comprises mucosa-associated lymphoid tissue (MALT) and non-MALT lymphomas. Both types of lymphoma vary in prognosis and treatment. The aim of this study was to explore CT and MRI characteristics of these two types of lymphoma. METHODS 61 cases of parotid NHL, 34 MALT and 27 non-MALT lymphomas with histopathological confirmation were examined with routine CT and MR scans prior to treatment, and retrospectively reviewed. RESULTS On CT and MRI, 34 MALT lymphomas presented with 11 solid and 23 solid-cystic forms, whereas 27 non-MALT lymphomas presented with 25 solid and 2 solid-cystic forms (p < 0.01). CONCLUSIONS Parotid MALT lymphoma is characterized mainly by the solid-cystic form, whereas non-MALT lymphoma is characterized mainly by the solid form. The differences on CT and MRI can offer helpful information for differentiation of both types of parotid NHL.
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Affiliation(s)
- L Zhu
- Department of Radiology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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[Non-Hodgkin lymphoma of maxillofacial soft tissue: a report of two cases and review of the literature]. Cancer Radiother 2013; 17:229-32. [PMID: 23665292 DOI: 10.1016/j.canrad.2013.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 01/24/2013] [Accepted: 01/30/2013] [Indexed: 11/21/2022]
Abstract
The extranodal non-Hodgkin lymphomas of maxillofacial soft tissues are rare. We report two cases of maxillofacial soft tissue non-Hodgkin lymphoma treated with chemotherapy followed by localized radiotherapy with complete remission after 3 and 6 months. We study the clinical, radiological and histopathological features as well as the treatment and the prognosis of extranodal non-Hodgkin lymphomas maxillofacial muscles.
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Xie CM, Liu XW, Mo YX, Li H, Geng ZJ, Zheng L, Lv YC, Ban XH, Zhang R. Primary nasopharyngeal non-Hodgkin’s lymphoma: imaging patterns on MR imaging. Clin Imaging 2013; 37:458-64. [DOI: 10.1016/j.clinimag.2012.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 06/20/2012] [Accepted: 07/25/2012] [Indexed: 11/24/2022]
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Hartman MJ, Gentry LR. Aggressive inflammatory and neoplastic processes of the paranasal sinuses. Magn Reson Imaging Clin N Am 2012; 20:447-71. [PMID: 22877951 DOI: 10.1016/j.mric.2012.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Although uncommon, sinonasal malignancies and aggressive inflammatory processes are entities every radiologist will encounter during the evaluation of routine sinus imaging studies. A high index of suspicion is necessary for prompt diagnosis. It is important to consider aggressive inflammatory disease in all patients having routine sinus computed tomography because any delay in diagnosis can adversely affect the patients' care. Magnetic resonance (MR) will often provide a better assessment of the lesion extent, allowing for better surgical treatment. MR is crucial for the accurate assessment of neoplastic lesions. A proficient understanding of the complex anatomy of the region is essential.
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Affiliation(s)
- Michael J Hartman
- Department of Radiology, University of Wisconsin Hospital, Madison, WI 53711, USA.
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Primary extranodal non-Hodgkin's lymphoma involving masseter and buccinator muscles. Int J Oral Maxillofac Surg 2012; 41:1393-6. [PMID: 22464613 DOI: 10.1016/j.ijom.2011.09.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 09/15/2011] [Indexed: 11/22/2022]
Abstract
Extranodal lymphoma of the head and neck comprises a heterogeneous group of tumours with different histological types, modes of presentation and prognosis. Lymphomatous involvement of skeletal muscles and particularly muscles of mastication and facial expression is extremely rare, but primary muscle lymphoma should be considered in the differential diagnosis of muscle masses. This article highlights clinical, radiological and histopathological findings of primary extranodal non-Hodgkin's lymphoma involving masseter and buccinator muscles in an immunocompetent patient.
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Cho KS, Kang DW, Kim HJ, Lee JK, Roh HJ. Differential Diagnosis of Primary Nasopharyngeal Lymphoma and Nasopharyngeal Carcinoma Focusing on CT, MRI, and PET/CT. Otolaryngol Head Neck Surg 2012; 146:574-8. [DOI: 10.1177/0194599811434712] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective. No study has done a comparative analysis of radiologic imaging findings between primary nasopharyngeal lymphoma (PNL) and nasopharyngeal carcinoma (NPC). The purpose of this study was to analyze computed tomography (CT) and magnetic resonance (MR) images and to evaluate the maximum standardized uptake value (SUV max) of positron emission tomography (PET)/CT between PNL and NPC, knowing the imaging features that distinguish PNL from NPC. Study Design. Cross-sectional study. Setting. University tertiary care facility. Subjects and Methods. The authors analyzed the features on CT, MR imaging, and PET/CT of 16 patients diagnosed with PNL and 32 patients diagnosed with NPC histopathologically. Results. Patients with PNL had a larger tumor volume and showed symmetry of tumor shape than did patients with NPC. Patients with PNL also had higher tumor homogeneity than NPC patients on CT, T2-weighted, and postcontrast MR images. All PNL patients showed a high degree of enhancement without invasion to the adjacent deep structure. The involvement of the Waldeyer ring was significantly higher in PNL patients. Cervical and retropharyngeal lymphadenopathy and PET/CT SUV max showed no significant difference between PNL and NPC. Conclusions. If the images present a bulky, symmetric nasopharyngeal mass with marked homogeneity, a high degree of enhancement, and a higher Waldeyer ring involvement combined with no invasion into the deep structure, PNL should be considered over NPC.
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Affiliation(s)
- Kyu-Sup Cho
- Department of Otorhinolaryngology and Medical Research Institute, Pusan National University School of Medicine, Busan, South Korea
| | - Dae-Woon Kang
- Department of Otorhinolaryngology and Medical Research Institute, Pusan National University School of Medicine, Busan, South Korea
| | - Hak-Jin Kim
- Department of Radiology, Pusan National University School of Medicine, Busan, South Korea
| | - Jong-Kil Lee
- Department of Otorhinolaryngology and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Hwan-Jung Roh
- Department of Otorhinolaryngology and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
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Dare AO, Datta RV, Loree TR, Hicks WL, Grand W. Sinonasal Non-Hodgkin's Lymphoma with Skull Base Involvement. Skull Base 2011; 11:129-35. [PMID: 17167612 PMCID: PMC1656785 DOI: 10.1055/s-2001-14433] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Non-Hodgkin's lymphoma (NHL) is a rare tumor of the skull base. As the incidence of primary central nervous system (CNS) lymphoma has increased, atypical presentations involving the skull or cranial base exclusively have been reported. In immunocompetent patients with no previous history or predisposing factors, the diagnosis of primary NHL of the skull base may be delayed. We present four cases of nasal and paranasal sinus NHL with both skull base and intracranial involvement in immunocompetent patients. Clinicopathologic correlation suggests that cranial base and intracranial involvement with NHL represents advanced-stage primary sinonasal disease. Surgical biopsy before definitive treatment is recommended. Radiation therapy provides local control; adjuvant chemotherapy after primary radiation therapy may be required for recurrent disease.
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Thomas S, Nair P, Kumar A, Hegde K, Singh V. A young boy with a maxillary swelling and closed rhinolalia. BMJ Case Rep 2011; 2011:2011/jan03_1/bcr0820103234. [PMID: 22715226 DOI: 10.1136/bcr.08.2010.3234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Non-Hodgkin's lymphoma belongs to a group of lymphoid neoplasia that is diverse in the manner of presentation, response to therapy and progress. The most common region for extranodal lymphoma is the gastrointestinal tract while for oral cavity buccal vestibule, posterior hard palate or gingiva is the common site. The maxilla is affected more commonly than the mandible. The oral picture being the sole manifestation highlights the importance of bearing this entity in the differential diagnosis of swelling in the jaws.
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Affiliation(s)
- Shaji Thomas
- Department of Oral & Maxillofacial Surgery, People's College of Dental Sciences and Research Centre, Bhopal, India
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Huang PC, Liu CY, Chuang WY, Shih LY, Wan YL. Ultrasound-guided core needle biopsy of cervical lymphadenopathy in patients with lymphoma: the clinical efficacy and factors associated with unsuccessful diagnosis. ULTRASOUND IN MEDICINE & BIOLOGY 2010; 36:1431-1436. [PMID: 20800170 DOI: 10.1016/j.ultrasmedbio.2010.05.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 04/09/2010] [Accepted: 05/17/2010] [Indexed: 05/29/2023]
Abstract
This study attempts to identify factors that influence the success or failure of subclassifying 154 cases of neck lymphoma by ultrasound-guided core needle biopsy (UGCNB). Variables including age, gender, nodal size, cutting needle bore, number of core tissues obtained, presence of nodal necrosis or infarct, fragmentation of the specimens and subclassification of lymphoma were reviewed and statistically analyzed to check if they were related to the success of UGCNB. UGCNB was successful in subclassifying lymphoma in 138 (89.7%) cases, in diagnosing lymphoma in 11 (7.1%) and unsuccessful in diagnosing lymphoma in five (3.2%) cases. No complications were encountered. The factors leading to failure in subclassification included the presence of composite lymphoma (p = 0.001), nodal necrosis or infarct (p = 0.001) and insufficiency or fragmentation of the specimens (p < 0.001). UGCNB is a safe and efficient procedure in subclassifying lymphoma. It may obviate surgical biopsy in 89.7% of cases.
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Affiliation(s)
- Pei Ching Huang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taiwan
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B lymphoblastic lymphoma presenting as a tumor of the nasopharynx in an adult patient. Head Neck Pathol 2010; 4:318-23. [PMID: 20730608 PMCID: PMC2996508 DOI: 10.1007/s12105-010-0206-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 08/10/2010] [Indexed: 10/19/2022]
Abstract
In adults, non-Hodgkin's lymphoma (NHL) is the second most common neoplasm found in the head and neck region after squamous cell carcinoma. Within this region, primary NHL of the nasopharynx is rare. We report the case of a 28-year-old male diagnosed with a B lymphoblastic lymphoma (CD20-; CD79a+; CD3-; CD10+; PAX5+, CyclinD1-; TdT+) of the nasopharynx extending to the deep and superficial structures of the right hemiface, to the skull base with an intracranial component and a small but detectable bone marrow involvement, who was started on chemotherapy with a complete response. To the best of our knowledge, this is the first case of a primary nasopharynx B-LBL in an adult patient with such aggressive regional spread to be reported in the literature.
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Aiken AH, Glastonbury C. Imaging Hodgkin and non-Hodgkin lymphoma in the head and neck. Radiol Clin North Am 2008; 46:363-78, ix-x. [PMID: 18619385 DOI: 10.1016/j.rcl.2008.03.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Hodgkin (HL) and non-Hodgkin lymphoma (NHL) involving the head and neck have many overlapping imaging features. Definitive diagnosis depends on histology, but imaging trends may help distinguish lymphoma from other common pathologic entities in the head and neck. CT is useful for staging and assessing bony involvement, whereas MR imaging is performed for soft tissue detail in extranodal disease, especially when there is transpatial disease or intracranial or intraspinal extension. Positron emission tomography has become an important part of staging and surveillance imaging and is particularly useful to distinguish posttreatment fibrosis and residual tumor.
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Affiliation(s)
- Ashley H Aiken
- Department of Radiology, San Francisco General Hospital, University of California San Francisco, 1001 Potrero Avenue, Room 1x55, San Francisco, CA 94110, USA.
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Yonemori K, Kusumoto M, Matsuno Y, Tateishi U, Watanabe SI, Watanabe T, Moriyama N. Diffuse large B-cell lymphoma presenting as a unilateral solitary round pulmonary hilar node infarction. Respirology 2006; 11:224-6. [PMID: 16548911 DOI: 10.1111/j.1440-1843.2006.00836.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Unilateral solitary pulmonary hilar node adenopathy is a rare presentation of diffuse large B-cell lymphoma. In this report, the authors present a case with a solitary pulmonary hilar lymph node infarction caused by diffuse large B-cell lymphoma. Enhanced CT examinations revealed a well-defined round mass with homogenous low attenuation in the left pulmonary hilum. Both radiological imaging and pathological examination can provide useful information for the interpretation of abnormalities and may enable the diagnosis of rare aetiologies.
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Affiliation(s)
- Kan Yonemori
- Division of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan.
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Abstract
This article reviews imaging-based nodal classification, recent advancements in MR imaging techniques for lymph node imaging, and characteristics of MR imaging for necklymphadenopathy. Further technical development of MR imaging is necessary to improve accuracy of diagnosis of lymph node metastases in patients with no head and neck cancer. Development of new tissue-specific MR contrast agents and functional imaging studies to address biologic activity of lymph nodes is essential in the future.
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Affiliation(s)
- Makiko Ishikawa
- Department of Radiology, University of Washington, Box 357115, 1959 Northeast Pacific Street, Seattle, WA 98195-7115, USA
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King AD, Lei KI, Ahuja AT. MRI of neck nodes in non-Hodgkin's lymphoma of the head and neck. Br J Radiol 2004; 77:111-5. [PMID: 15010382 DOI: 10.1259/bjr/53555208] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The aim of this study is to describe the imaging features of neck nodes in non-Hodgkin's lymphoma (NHL). The MR scans of 61 patients undergoing staging of a primary extranodal NHL of the head and neck were reviewed retrospectively. Those MR images with nodal disease were assessed for (a) the pattern of nodal disease, (b) presence of nodal necrosis and (c) presence of extracapsular neoplastic spread (ENS) and nodal matting. The features of the nodal disease were analysed in relationship to the sites of the primary NHL (palatine tonsil (PT) n=23, nasal cavity (NC) n=24, nasopharynx (NP) n=6, other extralymphatic sites (OES) n=8), and histology (natural killer/T-cell (NK/T) n=26, diffuse large cell (DLC) n=24, other subtypes (OS) n=11). Nodal disease was present in 26 patients (43%) and occurred in NHL of the PT n=16 (70%), NP n=3 (50%), NC n=5 (21%) and OES n=2 (25%) and in DLC n=15 (63%), NK/T n=6 (23%) and OS n=5 (45%). Nodal disease was significantly more frequent in DLC than NK/T lymphomas (p=0.0053). Nodal disease spread in a contiguous fashion in 25 (96%) patients with nodes. Necrosis was present in 7 of 26 (27%) being present in DLC of the PT in 5, NK/T of the NP in one and NK/T of the NC in one. ENS and matting were present in 19 (73%) and 13 (50%) patients with nodes, respectively. ENS was found in DLC, NK/T, OS, NC, NP, PT, OES (11, 4, 4,1, 2, 14, 2, respectively) and matting was found in DLC, NK/T, OS, NC, NP, PT, OES (9, 3, 1, 0, 2, 10, 1, respectively). Nodal NHL spreads in a contiguous fashion and is most commonly associated with DLC lymphoma of the NP and PT in Waldeyer's ring. Extracapsular nodal spread is frequent and found in most histological subtypes especially those arising from Waldeyer's ring. Necrosis is more common than previously believed.
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Affiliation(s)
- A D King
- Department of Diagnostic Radiology and Organ Imaging, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
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25
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Abstract
OBJECTIVE Nasopharyngeal (NP) non-Hodgkin's lymphoma (NHL) is an uncommon tumour. The aim of the study was to describe the appearances on CT and MR imaging, and identify the features which help to distinguish NPNHL from other NP tumours. MATERIALS AND METHODS The CT (n=8) and MR (n=10) images of 14 patients with NPNHL were reviewed retrospectively. Patients with NPNHL were divided into primary NPNHL, where the primary tumour was in the NP (n=7) and secondary NPNHL where the primary tumour was at another extranodal site in the head and neck (n=7). All NPNHL were assessed for tumour size and distribution, appearance and local tumour invasion, in addition lymphadenopathy was assessed in primary NPNHL. RESULTS The NPNHL ranged in size from 20-75 mm (mean of 55 mm for primary and 30 mm for secondary NHL) and were homogeneous on CT in eight (100%) and MR in seven (70%) and mildly heterogeneous on MR in three (30%) patients. NPNHL involved all walls of the NP in 10 (71%) (n=1). Primary NPNHL extended superficially in five (71%) to involve the nasal cavity (n=3) and oropharynx (n=2) and lymphadenopathy was present in five (71%) being bilateral and involving multiple nodal sites (n=4) with necrosis (n=2) and matting (n=3). CONCLUSION NPNHL is a homogeneous tumour that tends to diffusely involve all walls of the nasopharynx and spread in an exophytic fashion to fill the airway, rather than infiltrating into the deep tissues. Deep tumour infiltration, when it occurs, is found in those patients with primary NHL and is usually limited in extent and of small volume. and extended in an exophytic fashion to fill the NP cavity in six (43%). Deep tumour invasion was present in two (14%) both patients with primary NHL, the extent and volume of this tumour invasion was small and involved the prevertebral muscles (n=2), parapharyngeal fat space (n=1) and skull base Primary NHL more commonly spreads superficially to involve the nasal cavity or oropharynx, lymphadenopathy is frequent and extensive. A large tumour that fills the nasopharynx, with no or minimal invasion into deep structures, and a propensity to extend down into the tonsil, rather than up into the skull base, may suggest the diagnosis of NHL over nasopharyngeal carcinoma.
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Affiliation(s)
- A D King
- Department of Diagnostic Radiology and Organ Imaging, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong S.A.R., People's Republic of China.
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26
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Abstract
This article reviews imaging-based nodal classification, recent advancements in MR techniques for lymph node imaging, and characteristics of MR imaging for neck lymphadenopathy. Further technical development of MR imaging is necessary to improve accuracy of lymph node metastases in patients with N0 neck. Development of new tissue-specific MR contrast agents and functional imaging studies to address biologic activity of lymph nodes are essential in the future.
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Affiliation(s)
- Makiko Ishikawa
- Department of Radiology, University of Washington, Box 357115, 1959 Northeast Pacific Street, Seattle, WA 98195-7115, USA
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27
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Saito A, Takashima S, Takayama F, Kawakami S, Momose M, Matsushita T. Spontaneous extensive necrosis in non-Hodgkin lymphoma: prevalence and clinical significance. J Comput Assist Tomogr 2001; 25:482-6. [PMID: 11351202 DOI: 10.1097/00004728-200105000-00024] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE We studied the prevalence of spontaneous extensive necrosis in the nodes of patients with non-Hodgkin lymphomas and assessed the clinical significance of this finding. METHOD CT and MRI performed before initiation of radiation or chemotherapy were reviewed in 60 consecutive patients with non-Hodgkin lymphomas to evaluate the presence or absence of spontaneous extensive necrosis in the lymphomatous nodes. The results were correlated with histopathologic grading, stages of lymphomas, maximal axial diameters of the lesions, International Prognostic Index (IPI), age, and serum lactate dehydrogenase (LDH) levels. We then performed Kaplan-Meier analysis of disease-free survival using each factor. RESULTS Extensive necrotic nodes that appeared as rim-enhanced masses on enhanced CT or MR images were found in 15 patients (25%), of whom 10 patients had pathologic verification. The patients with necrosis had significantly higher stages (Stage II or higher), greater IPI (IPI of > or = 2), and higher serum LDH levels than those without necrosis (p = 0.001, p = 0.005, and p = 0.005, respectively). With the Kaplan-Meier method, a statistically significant difference was noted for serum LDH levels (p = 0.015) and IPI (p = 0.021) but not for extensive necrosis (p = 0.600). CONCLUSION Spontaneous extensive necrosis in lymphomatous nodes is not a rare event. This finding may have a prognostic significance for patients with non-Hodgkin lymphomas.
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Affiliation(s)
- A Saito
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
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28
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Abstract
Non-Hodgkin's lymphoma (NHL) arising primarily in the palatine tonsil is uncommon. The aims of the study were to describe the appearances on MRI and to identify the features that help to distinguish NHL from other tonsillar tumours. The clinical records and MR images of eight patients with primary NHL of the palatine tonsil were reviewed. Patients had a short duration of symptoms (mean 1 month). Systemic symptoms (fever, weight loss or night sweats) occurred in two patients. Tumours were round or lobulated and ranged in size from 30 mm to 70 mm. The signal intensity on T2 weighted, T1 weighted and T1 weighted contrast enhanced images was homogeneous and similar to that of normal tonsil in six patients. Two large tumours were mildly heterogeneous and one of these showed small foci of necrosis. NHL of the tonsil displaced rather than invaded local structures in seven patients and locally invaded the soft palate in only one patient. Lymphadenopathy was present in five patients and the nodes were of similar signal intensity to the primary tumour. There was involvement of the ipsilateral upper internal jugular chain in all cases of lymphadenopathy. The posterior triangle was involved in two patients, the periparotid node in one patient and the retro-oropharyngeal region in one patient. The presence of a large tumour without deep invasion together with homogeneous non-necrotic nodes suggests the diagnosis of NHL. As NHL frequently has similar signal intensity to normal tonsil, MRI may not be able to detect lymphomatous involvement in the non-enlarged tonsil.
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Affiliation(s)
- A D King
- Department of Diagnostic Radiology and Organ Imaging, Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
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Abstract
The identification and classification of cervical lymphadenopathy can be a challenging task for the general radiologist. Patients with a wide range of clinical presentation and disease states are often referred for imaging, although evaluation and staging of head and neck cancer is the most common indication. In addition to metastatic squamous carcinoma of the upper aerodigestive tract, the differential diagnosis of enlarged cervical lymph nodes includes the following: bacterial, mycobacterial and viral infections, granulomatous conditions such as sarcoidosis, primary and secondary involvement in lymphoma; other metastatic neoplasms such as from breast and lung, as well as more uncommon conditions such as sinus histiocytosis, eosinophilic granuloma, Kimura's disease, and Kikuchi's disease. This article will review the anatomy and regional classification of the cervical lymph node chains and discuss the common and uncommon etiologies of cervical lymph node enlargement.
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Affiliation(s)
- A V Kaji
- Allegheny University Hospitals, MCP Division, Philadelphia, PA 19129, USA
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