spinales Lymphom

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spinal osseous lesions: a case review series. Lymphoma. Axial CT images through the lumbar spine (a) and sacrum (b) demonstrate abnormal soft tissue within the spinal canal (black arrows). Additionally, there is soft tissue replacement of the normal fat in the right sacral foramen (orange arrow). T2-weighted MR image (c) of the lumbosacral spine demonstrates an intermediate to low signal lesion involving the posterior aspect of L5, and another component at S1-S2 (orange arrows). There is no involvement of the intervertebral discs. Post-contrast T1-weighted fat-suppressed image (d) demonstrates relatively homogeneous enhancement

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spinales Lymphom

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Lymphoma (historically lymphosarcoma was used for diffuse forms of the disease) is a malignancy arising from lymphocytes or lymphoblasts. Lymphoma can be restricted to the lymphatic system or can arise as extranodal disease. This, along with variable aggressiveness results in a diverse imaging appearance.

Epidemiology

Lymphoma accounts for ~4% of all cancers . They are more common in developed countries.

In children, lymphoma accounts for 10-15% of all cancers, being the third most common form of malignancy .

Clinical presentation

Lymphoma can present as nodal or extranodal disease. Hodgkin lymphoma and low-grade non-Hodgkin lymphoma (NHL) classically present as nodal disease, whereas high-grade NHL can present with complications from mass effect such as superior vena cava obstruction, cauda equina syndrome, etc. Extranodal disease can affect any organ.

Lymphoma can often present with B symptoms (fever, night sweats and weight loss).

Pathology

Lymphomas are a malignancy that arise from mature lymphocytes. The etiology is unknown but potential lymphomatogenic risk factors include :

viral infection, e.g. EBV, HTLV-1, HIV, HCV, HSV
bacterial infection, e.g. Helicobacter pylori
chronic immunosuppression, e.g. post-transplantation
prior chemotherapy (especially alkalising agents) and drug therapy, e.g. digoxin

Classification

Lymphomas are currently classified according to the 2008 WHO classification of tumors of hematopoietic and lymphoid tissues. The main division is into:

Hodgkin lymphoma (Hodgkin disease) (40%)
non-Hodgkin lymphoma (60%)
- mature B-cell lymphoma
- mature T-cell and NK-cell lymphoma
- post-transplant lymphoproliferative disorders

The majority (85%) of lymphomas are B-cell with the remainder (15%) being T-cell .

Location

Additionally, it is worth, especially for radiologists, dividing extranodal lymphomas according to the location:

central nervous system (CNS)
head and neck lymphoma
thoracic lymphoma
gastrointestinal lymphoma
hepatobiliary lymphoma
musculoskeletal lymphoma
cutaneous lymphoma
- mycosis fungoides
- Sezary syndrome
genitourinary lymphoma
multi-regional
- MALT lymphoma

Radiographic features

Imaging characteristics will depend on the location and subtype of lymphoma. CT is the workhorse of imaging in lymphoma and plays a crucial role in staging (see main article: lymphoma staging). US and MRI are also used; for example, when assessing cervical lymph nodes (US) or CNS lymphoma (MRI). FDG-PET is used for staging and re-staging of lymphoma.

Treatment and prognosis

Lymphoma cure rates are comparatively high (up to 90%) compared to many other malignancies. Prognosis depends not only on histological subtype and grade but also on stage, hence why imaging plays a pivotal role in treatment. Aggressive lymphomas (e.g. Burkitt lymphoma) typically have a prognosis of weeks without treatment.