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

References:
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:

Site	Frequency	Characteristics	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	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.
Heart	Rare
Chest Wall	Rare
Stomach	Rare
Small Intestine	Rare
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.
Thyroid	Very Rare