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Metastatic Pattern of Spread of Hodgkin's Lymphoma  adultchild

Introduction: A lymphoma typically arising within the mediastinum and most commonly affecting young adults. Hematogenous (extranodal) metastases occur in approximately 5-10% of cases. Most commonly, Hodgkin's lymphoma spreads to local lymph nodes via lymphatics (in contrast to non-Hodgkin's lymphomas, which are typically hematogenously disseminated to other lymph nodes).

Prevalence: Rare Metastasis Frequency: Rare

Radiographics. 2001 Jan-Feb;21(1):161-79. PMID: 11158651

Radiographics. 2007 Sep-Oct;27(5):1335-54 PMID: 17848695

Primary Tumor:

 Characteristics Comments
Mediastinum Hypodense, Heterogeneous Anterior mediastinum most common site for nodular sclerosing Hodgkin's.

Known Metastatic Locations:

SiteFrequencyCharacteristics Comments
Local Lymph Nodes Common Spreads contiguously. Most commonly to hilar or cervical chain.
Thymus Common Thymic involvement is considered 'just another lymph node' for staging purposes.
Spleen CommonHypoenhancing, Splenomegaly Most commonly radiographically occult, but can present with hypoattenuating nodules or as splenomegaly. Splenomegaly (especially mild) does not imply involvement, however.
Distant Lymph Nodes Common
Pleura UncommonEffusion, Mass Pleural effusions occur much more often than direct invasion and typically are not malignant (thus do not confer a worse prognosis).
Liver UncommonHepatomegaly, Hypoenhancing Never occurs without splenic involvement first. Imaging is unreliable (hepatomegaly does not imply involvement).
Lung Parenchyma RareLymphangiitic, Nodule, Consolidation can also invade locally from the hilum or mediastinum. Most common pattern is nodules.
Heart Rare
Chest Wall Rare
Stomach Rare
Small Intestine Rare
Bone Marrow Rare Usually a late finding. MRI is most sensitive.
Bone RareBlastic, Mixed Lytic and Blastic, Lytic Most commonly involves the spine. Involves bone usually by direct extension.
Thyroid Very Rare