Extranodal Lymphomas: a pictorial review for CT and MRI classification

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Alfonso Reginelli
Fabrizio Urraro
Angelo Sangiovanni
Gaetano Maria Russo
Carolina Russo
Roberta Grassi
Andrea Agostini
Maria Paola Belfiore
Michaela Cellina
Chiara Floridi
Andrea Giovagnoni
Antonello Sica
Salvatore Cappabianca


Extranodal lymphomas, Computed Tomography, Magnetic Resonance Imaging.


Extranodal lymphomas represent an extranodal location of both non-Hodgkin and Hodgkin lymphomas. This study aims to evaluate the role of CT and MRI in the assessment of relationships of extranodal lymphomas with surrounding tissues and in the characterization of the lesion. We selected and reviewed ten recent studies among the most recent ones present in literature exclusively about CT and MRI imaging of extranodal lymphomas. Contrast-enhanced computed tomography (CT) is usually the first-line imaging modality in the evaluation of extranodal lymphomas, according to Lugano classification. However, MRI has a crucial role thanks to the superior soft-tissue contrast resolution, particularly in the anatomical region as head and neck.


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1. Guermazi A, Brice P, de Kerviler EE, et al. Extranodal Hodgkin disease: spectrum of disease. Radiographics : a review publication of the Radiological Society of North America, Inc 2001; 21: 161-79.
2. Gurney KA, Cartwright RA. Increasing incidence and descriptive epidemiology of extranodal non-Hodgkin lymphoma in parts of England and Wales. The hematology journal : the official journal of the European Haematology Association 2002; 3: 95-104.
3. Even-Sapir E, Lievshitz G, Perry C, Herishanu Y, Lerman H, Metser U. Fluorine-18 fluorodeoxyglucose PET/CT patterns of extranodal involvement in patients with Non -Hodgkin lymphoma and Hodgkin’s disease. Radiologic clinics of North America 2007; 45: 697-709, vii.
4. Groves FD, Linet MS, Travis LB, Devesa SS. Cancer surveillance series: non-Hodgkin’s lymphoma incidence by histologic subtype in the United States from 1978 through 1995. Journal of the National Cancer Institute 2000; 92: 1240-51.
5. Zucca E, Conconi A, Cavalli F. Treatment of extranodal lymphomas. Best practice & research. Clinical haematology 2002; 15: 533-47.
6. Vannata B, Zucca E. Primary extranodal B-cell lymphoma: current concepts and treatment strategies. Chinese clinical oncology 2015; 4: 10.
7. Paes FM, Kalkanis DG, Sideras PA, Serafini AN. FDG PET/CT of extranodal involvement in non-Hodgkin lymphoma and Hodgkin disease. Radiographics : a review publication of the Radiological Society of North America, Inc 2010; 30: 269-91.
8. Thomas AG, Vaidhyanath R, Kirke R, Rajesh A. Extranodal lymphoma from head to toe: part 1, the head and spine. AJR. American journal of roentgenology 2011; 197: 350-6.
9. Urquhart A, Berg R. Hodgkin’s and non-Hodgkin’s lymphoma of the head and neck. The Laryngoscope 2001; 111: 1565-9.
10. Watal P, Bathla G, Thaker S, Sato TS, Moritani T, Smoker WRK. Multimodality Imaging Spectrum of the Extranodal Lymphomas in the Head and Neck-A Pictorial Review. Current problems in diagnostic radiology 2018; 47: 340- 352.
11. Glass AG, Karnell LH, Menck HR. The National Cancer Data Base report on non-Hodgkin’s lymphoma. Cancer 1997; 80: 2311-20.
12. Kostakoglu L, Goldsmith SJ. Fluorine-18 fluorodeoxyglucose positron emission tomography in the staging and follow- up of lymphoma: is it time to shift gears? European journal of nuclear medicine 2000; 27: 1564-78.
13. Das J, Ray S, Sen S, Chandy M. Extranodal involvement in lymphoma - A Pictorial Essay and Retrospective Analysis of 281 PET/CT studies. Asia Oceania journal of nuclear medicine & biology 2014; 2: 42-56.
14. Agliata G, Schicchi N, Agostini A, et al. Radiation exposure related to cardiovascular CT examination: comparison between conventional 64-MDCT and third-generation dualsource MDCT. La Radiologia medica 2019; 124: 753-761.
15. Floridi C, Radaelli A, Pesapane F, et al. Clinical impact of cone beam computed tomography on iterative treatment planning during ultrasound-guided percutaneous ablation of liver malignancies. Medical oncology (Northwood, London, England) 2017; 34: 113.
16. Agostini A, Kircher MF, Do R, et al. Magnetic Resonance Imaging of the Liver (Including Biliary Contrast Agents) Part 1: Technical Considerations and Contrast Materials. Seminars in roentgenology 2016; 51: 308-316.
17. Panfili E, Nicolini D, Polverini V, Agostini A, Vivarelli M, Giovagnoni A. Importance of radiological detection of early pulmonary acute complications of liver transplantation: analysis of 259 cases. La Radiologia medica 2015; 120: 413- 20.
18. Agostini A, Mari A, Lanza C, et al. Trends in radiation dose and image quality for pediatric patients with a multidetector CT and a third-generation dual-source dual-energy CT. La Radiologia medica 2019; 124: 745-752.
19. Agostini A, Kircher MF, Do RK, et al. Magnetic Resonanance Imaging of the Liver (Including Biliary Contrast Agents)-Part 2: Protocols for Liver Magnetic Resonanance Imaging and Characterization of Common Focal Liver Lesions. Seminars in roentgenology 2016; 51: 317-333.
20. Paolicchi F, Bastiani L, Guido D, Dore A, Aringhieri G, Caramella D. Radiation dose exposure in patients affected by lymphoma undergoing repeat CT examinations: how to manage the radiation dose variability. La Radiologia medica 2018; 123: 191-201.
21. Cheson BD, Fisher RI, Barrington SF, et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2014; 32: 3059-68.
22. Regacini R, Puchnick A, Luisi FAV, Lederman HM. Can diffusion-weighted whole-body MRI replace contrast-enhanced CT for initial staging of Hodgkin lymphoma in children and adolescents? Pediatric radiology 2018; 48: 638-647.
23. Hopper KD, Kasales CJ, Van Slyke MA, Schwartz TA, TenHave TR, Jozefiak JA. Analysis of interobserver and intraobserver variability in CT tumor measurements. AJR. American journal of roentgenology 1996; 167: 851-4.
24. Matsuzaki H, Hara M, Yanagi Y, et al. Magnetic resonance imaging (MRI) and dynamic MRI evaluation of extranodal non-Hodgkin lymphoma in oral and maxillofacial regions. Oral surgery, oral medicine, oral pathology and oral radiology 2012; 113: 126-133.
25. Chun CW, Jee WH, Park HJ, et al. MRI features of skeletal muscle lymphoma. AJR. American journal of roentgenology 2010; 195: 1355-60.
26. Muccio CF, Di Blasi A, Esposito G, Brunese L, D’Arco F, Caranci F. Perfusion and spectroscopy magnetic resonance imaging in a case of lymphocytic vasculitis mimicking brain tumor. Polish journal of radiology 2013; 78: 66-9.
27. Cozzi D, Dini C, Mungai F, Puccini B, Rigacci L, Miele V. Primary pulmonary lymphoma: imaging findings in 30 cases. La Radiologia medica 2019; 124: 1262-1269.
28. Marampon F, Gravina GL, Popov VM, et al. Close correlation between MEK/ERK and Aurora-B signaling pathways in sustaining tumorigenic potential and radioresistance of gynecological cancer cell lines. International journal of oncology 2014; 44: 285-94.
29. d’Amuri FV, Maestroni U, Pagnini F, et al. Magnetic resonance imaging of adrenal gland: state of the art. Gland surgery 2019; 8: S223-s232.
30. Bevilacqua A, D’Amuri FV, Pagnini F, et al. Percutaneous needle biopsy of retroperitoneal lesions: technical developments. Acta bio-medica : Atenei Parmensis 2019; 90: 62-67.
31. D’Amico G, Di Crescenzo V, Muto M, et al. Cytological diagnosis of limph nodes by instrumental guide: Ultrasonography and CT. Recenti progressi in medicina 2013; 104: 367-370.
32. Cipriani P, Di Benedetto P, Ruscitti P, et al. Perivascular Cells in Diffuse Cutaneous Systemic Sclerosis Overexpress Activated ADAM12 and Are Involved in Myofibroblast Transdifferentiation and Development of Fibrosis. J Rheumatol 2016; 43: 1340-9.
33. Giacomelli R, Liakouli V, Berardicurti O, et al. Interstitial lung disease in systemic sclerosis: current and future treatment. Rheumatology international 2017; 37: 853-863.
34. Frampas E. Lymphomas: Basic points that radiologists should know. Diagnostic and interventional imaging 2013; 94: 131-44.
35. Hesselmann V, Zahringer M, Krug B, et al. Computed-tomography- guided percutaneous core needle biopsies of suspected malignant lymphomas: impact of biopsy, lesion, and patient parameters on diagnostic yield. Acta radiologica (Stockholm, Sweden : 1987) 2004; 45: 641-5.
36. Frata P, Buglione M, Grisanti S, et al. Localized Extranodal Lymphoma of the Head and Neck: Retrospective Analysis of a Series of 107 Patients from a Single Institution. Tumori 2005; 91: 456-62.
37. Lee YY, Van Tassel P, Nauert C, North LB, Jing BS. Lymphomas of the head and neck: CT findings at initial presentation. AJR. American journal of roentgenology 1987; 149: 575-81.
38. Aiken AH, Glastonbury C. Imaging Hodgkin and non -Hodgkin lymphoma in the head and neck. Radiologic clinics of North America 2008; 46: 363-78, ix-x.
39. Kato H, Kanematsu M, Kawaguchi S, Watanabe H, Mizuta K, Aoki M. Evaluation of imaging findings differentiating extranodal non-Hodgkin’s lymphoma from squamous cell carcinoma in naso- and oropharynx. Clinical imaging 2013; 37: 657-63.
40. King AD, Lei KI, Richards PS, Ahuja AT. Non-Hodgkin’s lymphoma of the nasopharynx: CT and MR imaging. Clinical radiology 2003; 58: 621-5.
41. Nayak LM, Deschler DG. Lymphomas. Otolaryngologic clinics of North America 2003; 36: 625-46.
42. Yuen A, Jacobs C. Lymphomas of the head and neck. Seminars in oncology 1999; 26: 338-45.
43. Aviles A, Delgado S, Ruiz H, de la Torre A, Guzman R, Talavera A. Treatment of non-Hodgkin’s lymphoma of Waldeyer’s ring: radiotherapy versus chemotherapy versus combined therapy. European journal of cancer. Part B, Oral oncology 1996; 32b: 19-23.
44. Abbondanzo SL, Wenig BM. Non-Hodgkin’s lymphoma of the sinonasal tract. A clinicopathologic and immunophenotypic study of 120 cases. Cancer 1995; 75: 1281-91.
45. Van Prooyen Keyzer S, Eloy P, Delos M, Doyen C, Bertrand B, Rombaux P. Sinonasal lymphomas. Case report. Acta oto-rhino-laryngologica Belgica 2000; 54: 45-51.
46. Yasumoto M, Taura S, Shibuya H, Honda M. Primary malignant lymphoma of the maxillary sinus: CT and MRI. Neuroradiology 2000; 42: 285-9.
47. Das S, Kirsch CF. Imaging of lumps and bumps in the nose: a review of sinonasal tumours. Cancer imaging : the official publication of the International Cancer Imaging Society 2005; 5: 167-77.
48. Pedersen RK, Pedersen NT. Primary non-Hodgkin’s lym phoma of the thyroid gland: a population based study. Histopathology 1996; 28: 25-32.
49. Jaffe ES, Harris NL, Diebold J, Muller-Hermelink HK. World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues. A progress report. American journal of clinical pathology 1999; 111: S8-12.
50. Thieblemont C, Mayer A, Dumontet C, et al. Primary thyroid lymphoma is a heterogeneous disease. The Journal of clinical endocrinology and metabolism 2002; 87: 105-11.
51. Kim HC, Han MH, Kim KH, et al. Primary thyroid lymphoma: CT findings. European journal of radiology 2003; 46: 233-9.
52. Widder S, Pasieka JL. Primary thyroid lymphomas. Current treatment options in oncology 2004; 5: 307-13.
53. Matsuzuka F, Miyauchi A, Katayama S, et al. Clinical aspects of primary thyroid lymphoma: diagnosis and treatment based on our experience of 119 cases. Thyroid : official journal of the American Thyroid Association 1993; 3: 93-9.
54. Wolvius EB, van der Valk P, van der Wal JE, et al. Primary non-Hodgkin’s lymphoma of the salivary glands. An analysis of 22 cases. Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology 1996; 25: 177-81.
55. Hirokawa N, Hareyama M, Akiba H, et al. Diagnosis and Treatment of Malignant Lymphoma of the Parotid Gland. Japanese Journal of Clinical Oncology 1998; 28: 245-249.
56. Zhu L, Wang P, Yang J, Yu Q. Non-Hodgkin lymphoma involving the parotid gland: CT and MR imaging findings. Dentomaxillofac Radiol 2013; 42: 20130046-20130046.
57. Kantarci M, Erdem T, Alper F, Gundogdu C, Okur A, Aktas A. Imaging characteristics of diffuse primary cutaneous B-cell lymphoma of the cranial vault with orbital and brain invasion. AJNR. American journal of neuroradiology 2003; 24: 1324-6.
58. Jamjoom AB, Jamjoom ZA, Naim Ur R, Cheema MA. Primary midline cranial vault lymphoma simulating a parasagittal meningioma: the role of angiography in preoperative diagnosis. Neurosurgical review 1998; 21: 202-5.

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