Metastatic Pattern of Spread of Hodgkin's Lymphoma
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
|Mediastinum||Hypodense, Heterogeneous||Anterior mediastinum most common site for nodular sclerosing Hodgkin's.
Known Metastatic Locations:
|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||Common||Hypoenhancing, 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||Uncommon||Effusion, Mass||Pleural effusions occur much more often than direct invasion and typically are not malignant (thus do not confer a worse prognosis).
|Liver||Uncommon||Hepatomegaly, Hypoenhancing||Never occurs without splenic involvement first. Imaging is unreliable (hepatomegaly does not imply involvement).
|Lung Parenchyma||Rare||Lymphangiitic, Nodule, Consolidation||can also invade locally from the hilum or mediastinum. Most common pattern is nodules.
|Bone Marrow||Rare||Usually a late finding. MRI is most sensitive.
|Bone||Rare||Blastic, Mixed Lytic and Blastic, Lytic||Most commonly involves the spine. Involves bone usually by direct extension.