Abdominal and pelvic lymph nodes in non-Hodgkin lymphoma: the nodal distribution in Chinese patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the distribution of abdominal and pelvic lymph nodes involved in non-Hodgkin lymphoma in Chinese patients.</p><p><b>METHODS</b>CT images of 241 non-Hodgkin lymphoma patients with abdominal and pelvic lymph nodes involved were reviewed. Of them, 96 patients whose clinical and image data fulfilled the requirements of the analysis were included: 1. Positive abdominal and/or pelvic nodular lesion in untreated patients examined by CT (n = 74). 2. New lesions in abdominal or pelvic lymph nodes who never had any nodular lesion by previous abdominal and/or pelvic CT (n = 14). 3. Treated patients who did not have abdominal and/or pelvic CT before, showed regression of initial disease for at lease 6 months after chemotherapy and patients showing abdominal and/or pelvic nodal lesions (n = 8) were assessed. In accordance with Clinical Schema for the Lymphoid System, these patients were divided into 3 histology subtypes: indolent (IL; n = 31), aggressive (AL; n = 61) and very aggressive (VAL; n = 2) lymphoma. The remaining 2 cases were unclassified (UCL). Both abdominal and pelvic CT scans were undertaken in 46 patients, abdominal CT only in 47 patients and pelvic CT only in 3 patients. Enhanced CT with i.v. contrast was obtained in 80 patients. The anatomic sites involved were designated as retroperitoneal (i.e. paraaortic), mesenteric, abdominal (i.e. celiac, paracardiac, gastrohepatic, and hepatic hilar, etc), retrocrural, subdiaphragmatic, common iliac, internal iliac, external iliac, and inguinal nodes, respectively.</p><p><b>RESULTS</b>The lesions were located in the retroperitoneum, with an incidence of 83% for both IL and AL. These were predominantly seen superior and inferior to the renal hila, with incidences of 72.0% (18/25) in IL and 67.3% (33/49) in AL. Pelvic lymph nodes came the next, with incidences of 41.9% (126/301 sites of IL and AL), 57.5% (50/87 sites) in IL and 35.5% (76/214 sites) in AL. Mesenteric lymph nodes stood third with incidences of 37.1% (33/89 IL and AL), 43.3% (13/30) in IL and 33.9% (20/59) in AL. There was only one statistically significant evidence that the external iliac lymph nodes were much more commonly seen in IL than in AL (P < 0.05).</p><p><b>CONCLUSION</b>In Chinese patients, retroperitoneal, iliac, and mesenteric nodes are the most commonly involved lymph nodes in NHL. The involved retroperitoneal lymph nodes are predominantly located superior and inferior to the renal hila. The anatomic distribution of abdominal and pelvic lymph nodes in NHL of Chinese patients is different from that of the western countries.</p>

Imaging appearances of inflammatory pseudotumors of the spleen (report of 3 cases) / 中华放射学杂志

Objective　To improve the recognition of the imaging appearances of inflammatory pseudotumors of the spleen (IPS), 3 cases with IPS were reported. Methods　The US (n=3), CT (n=3) and MRI (n=1) findings of IPS were reviewed and correlated with the pathologic findings. Results　On US, a well-defined solitary mass with heterogeneous echo texture was found in all 3 cases. A hyperechoic rim with associated acoustic shadowing was shown in 1 case. In all of the 3 cases in nonenhanced CT scanning, a well-defined hypoattenuated mass was found. One had a calcified egg-shell-like rim; On the venous/delayed phase of enhanced CT after contrast administration in 2 cases, slight/marked enhancement was shown. On nonenhanced MRI in 1 case, the mass was shown as heterogeneous hypointensity on T1- and T2- weighted images. Conclusion　IPS should be included in the differented diagnosis of solitary mass lesion of spleen. The imaging findings depend on the variable proportions of fibrous and granulomatous components within the lesion. IPS was characterized by well-defined solitary mass on sonogram, delayed enhancement on enhanced CT, and hypointensity on T2 weighted MR images.

CT manifestations of lymph node metastasis of thyroid carcinoma / 中华放射学杂志

Objective To study the CT manifestations of metastatic lymph node of thyroid carcinoma. Methods CT appearances of metastatic lymph node of thyroid carcinoma proved by surgery and pathology in 108 patients were reviewed. Results Of these 108 cases, metastatic lymph nodes were located at superoir and middle internal jugular chain(n=76), inferior internal jugular chain and super clavicular region(n=86), tracheoesophageal groove(n=52), and superior mediastinum(n=17). Of 84 thyroid papillary carcinoma patients, the attenuation of metastatic lymph nodes were similar to that of normal thyroid gland(n=16), with cystic formations (n=24), intracystic high attenuation papillary-like nodules (n=18), and fine granular calcifications (n=11). Of 24 follicular carcinoma, medullary carcinoma, and clear cell carcinoma patients, 17 cases had significant homogeneous or heterogeneous enhanced nodes, and the attenuation was the same as primary or recurrent thyroid tumors. Conclusion For thyroid carcinoma, the most common locations of metastatic lymph nodes were internal jugular chain, tracheoesophageal groove, and superior mediastinum regions. Marked enhancement similar to normal thyroid gland, cystic formations with intracystic high attenuation papillary-like nodules, and fine discrete granular calcifications were the characteristic manifestations of metastatic lymph node of papillary carcinoma. Marked homogeneous or heterogeneous enhancement after contrast administration and the same attenuation as the primary or recurrent thyroid tumor were found in follicular carcinoma, medullary carcinoma, and clear cell carcinoma metastases.

CT manifestations of cervical lymph node pathology:lymphoma vs metastatic squamous cell carcinoma / 中华放射学杂志

Objective To evaluate the contrast enhanced CT manifestations of lymphoma involving cervical lymph node and to compare with features of metastatic squamous cell carcinoma. Methods CT findings of cervical lymph node were reviewed in 56 patients (male 44, female 12; age: 9-75 year, median 42 year) with untreated lymphoma and 66 patients (male 51, female 15; age: 16-76 year, median 48 year) with squamous cell carcinoma. Four patterns of enhanced nodes were identified: Type I: homogeneous enhancement with an attenuation equal or similar to that of muscle. Type Ⅱ: heterogeneous enhancement with an attenuation much higher than that of muscle. Type Ⅲ: central low density with peripheral enhancement. The enhanced rim was thick and irregular (ⅢA), or thin and regular (ⅢB). Type Ⅳ: central soft tissue density with a very thin enhanced capsule. Results There were various manifestations of cervical nodes of malignant lymphoma, more than one type of abnormalities could be found simultaneously. Type I(47/56, 83.9%) and Type Ⅳ(15/56, 26 8%) were almost exclusively found in lymphoma. Type Ⅱ was more commonly seen in squamous cell carcinoma (31/66, 47%), but was rarely seen in lymphoma (8/56, 14 3%). Type Ⅲ can be seen in both of these disease entities (lymphoma 21/56, 37 5%; squamous cell carcinoma 52/66, 78 8%) , but was more common in squamous cell carcinoma ( P

Pulmonary sclerosing hemangioma: correlation of radiographic and pathologic findings / 中华放射学杂志

Objective To study the radiographic features of pulmonary sclerosing hemangioma (PSH), and to correlate the imaging with the pathologic findings so as to improve the imaging diagnostic abilities. Methods The clinical features of 45 patients with pathology proved PSH between 1976 and 2002 were reviewed. Of the 45 patients, there were 3 men and 42 women, their age ranged from 18 to 67 years (median age, 49 years), and 19 patients were asymptomatic. 20 patients had chest radiography and CT scans. The radiographic findings were studied retrospectively and were correlated with that of pathology. (7 patients) underwent unenhanced CT and 13 patients had enhanced CT. Results Of the 20 patients who had chest X-ray, 18 patients presented as a solitary, round or oval shaped lesion with well-defined margin. On CT scans, the greatest dimension of the lesion ranged from 1.9 cm to 7.0 cm. A homogeneous soft-tissue attenuation was revealed on unenhanced scans. Homogeneous enhancement was detected in 9 patients and heterogeneous enhancement in 4 patients on enhanced CT. Cystic change was found in 1 patient showing lower attenuation than the enhanced solid tumor, and calcification was found in 5 patients. Correlation of radiographic and pathologic findings indicated that higher attenuation areas corresponded to the angiomatous areas. Conclusions PSH should be considered with the following features: (1) female patients between (40-60) years of age; (2) well-defined round or oval shaped lesion on chest radiography; (3) a homogeneous soft-tissue mass on unenhanced CT; cystic-like area within the tumor and/or calcification can occasionally be found; (4) homogeneous or heterogeneous enhancement after contrast administration.