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Extranodal manifestations of lymphoma

Department of Diagnostic Imaging, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK

Summary

• Extranodal manifestations of lymphoma are much commoner in non-Hodgkin's lymphoma (NHL) than in Hodgkin's disease (HD) and, with the increasing frequency of NHL, will be seen more often.
  
• At presentation, lung involvement is seen more frequently in HD (12%) than in NHL (4) and is almost always associated with mediastinal or hilar adenopathy.
  
• The sensitivity of cross-sectional imaging for the detection of splenic involvement remains low, as involvement is usually diffuse.
  
• The gastrointestinal tract is the commonest site of primary extranodal lymphoma and gastric involvement accounts for about 80% of all gastrointestinal lymphoma in adults.
  
• Genitourinary lymphoma is usually only seen in advanced disease, seldom at presentation. The testicles are the most common organ to be involved.
  
• Bone marrow involvement is present in a minority of patients with HD but in 20–40% of patients with NHL. MRI is the most sensitive imaging method of detecting involvement.
  
• Primary central nervous system lymphoma accounts for up to 30% of cases of NHL and is restricted almost entirely to the brain.