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Thursday, October 8, 2009

Lymphoma of the neck

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Lymphoma of the neck


Lymphoma of head and neck
Patterns of lymphomatous involvement of head and neck have been categorized into four types :
1-Nodal lymphoma
Unilateral
Bilateral

2-Extranodal lymphoma
Confined to Waldeyer's ring
Outside Waldeyer's ring (extralymphatic)
3-Combined extranodal/ nodal lymphoma
4-Multifocal, extranodal involvement

NHL comprises 5% of head and neck cancers. Extranodal disease is a more common presentation in non-Hodgkin's than in Hodgkin's lymphomas. It is the second most frequent site of extranodal lymphoma after the gastrointestinal tract. Approximately 40-60% of patients presenting with head and neck disease will have systemic NHL. For staging, gallium-67 scintigraphy has the advantage of assessing the total body with a relatively high rate of detecting abnormalities, but with relatively nonspecific findings. (This method will also detect inflammatory conditions as well as gallium-avid tumors.) CT and MRI depict the local extent of the disease.
NHL can be unilateral or bilateral, with extension from the nasopharynx to the tonsils. Masses are indistinguishable from squamous cell cancer (SCC), except that SCC is less frequently multicentric and more often produces bone destruction. Both onditions may be associated with lymph node enlargement. MR may help to distinguish paranasal sinus extension from accompanying postobstruction fluid (bright on T2).

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