LYMPHOMAS ULTRASOUND MANAGEMENT
Category: Diagnostic Radiology
Abstract : Lymphoma is the most common malignant disease affecting the spleen. Lymphomas
comprise a number of diseases, all malignant, which affect the lymphocytes.
Malignant cells can infiltrate the spleen, lymph nodes, bone marrow and thymus
and can also involve the liver, gastrointestinal tract, kidney and other organs.
Approximately 3% of malignant diseases are lymphomas. Splenic involvement may
Lymphoma is the most common malignant disease affecting the spleen. Lymphomas
comprise a number of diseases, all malignant, which affect the lymphocytes.
Malignant cells can infiltrate the spleen, lymph nodes, bone marrow and thymus
and can also involve the liver, gastrointestinal tract, kidney and other organs.
Approximately 3% of malignant diseases are lymphomas.
Splenic involvement may be
found in up to 60% of lymphomas as a result of dissemination of the disease.
Primary splenic lymphoma, limited to the spleen, is very rare, and accounts for
less than 1% of lymphomas. There are two main groups: Hodgkin’s and
non-Hodgkin’s lymphomas.
Clinical features and management
Patients may
present with a range of non-specific symptoms which include lymph node
enlargement, anaemia, general fatigue, weight loss, fever, sweating and
infections associated with decreased immunity. If the disease has spread to
other organs, these may produce symptoms related to the organs in
question.
Prognosis depends upon the type of the disease, which must be
determined histologically, and its stage. Both ultrasound and CT may be used in
staging: ultrasound demonstrates splenic involvement with greater sensitivity
than CT, and CT is superior in demonstrating para-aortic and iliac lymph nodes.
Bone scintigraphy and MRI are further supplementary techniques in staging.
Depending upon the type of lymphoma, chemotherapy regimes may be successful and,
if not curative, can cause remission for lengthy periods. High-grade types of
lymphoma are particularly aggressive with a poor survival
rate.
Ultrasound appearances
The range of possible ultrasound
appearances in lymphoma is varied. In many cases the spleen is not enlarged and
shows no acoustic abnormality. In a study of 61 patients with Hodgkin’s disease
involving the spleen, the organ was usually normal in size and showed no
acoustic abnormality in 46% of cases.
Lymphoma may produce a diffuse
splenic enlargement with normal, hypo- or hyperechogenicity. Focal lesions may
be present in up to 16% of lymphomas. They tend to be hypoechoic and may be
single or multiple, and of varying sizes. In larger lesions the margins may be
ill-defined and the echo contents vary from almost anechoic to heterogeneous,
often with increased through-transmission. In such cases, they may be similar in
appearance to cysts, however, the well-defined capsule is absent in lymphoma,
which has a more indistinct margin.
Smaller lesions may be hyperechoic or
mixed. Tiny lymphomatous foci may affect the entire spleen, making it appear
coarse in texture. Lymphadenopathy may be present elsewhere in the abdomen. If
other organs, such as the kidney or liver, are affected, the appearances of mass
lesions vary but are commonly echo-poor or of mixed echo pattern. A differential
diagnosis of metastases should be considered in the presence of multiple solid
hypoechoic splenic lesions, but most cases are due to lymphoma.
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