Soft Tissue Neck Mass -- Hodgkin's Lymphoma, Neck

Hodgkin's Lymphoma, Neck

• Subtle soft tissue swelling is present along the left side of the patient's neck.
  • The trachea is deviated to the right.
• Lung fields are clear.
• There is no definite evidence of mediastinal or hilar adenopathy.

Radiographic findings are consistent with a neck mass, subsequently proven to be Hodgkin's Lymphoma.

As per our discussion regarding tonsilar carcinoma, there is no way to make the diagnosis from the x-ray alone.

• Soft tissue mass in the neck is non-specific.
• Clinical history is important.
• The DDX includes:
  • Abscess
  • Hematoma
  • Lymphadenopathy
  • Vascular Masses
  • Congenital Abnormalities
  • Neoplasm
• CT scan
  • Can demonstrate the relationship of the mass to vessels and other structures.
  • Can help characterize the lesion.
  • Can serve as a guide for biopsy.
• Lymphomas demonstrate striking avidity for Gallium as demonstrated by this > Nuclear Medicine Gallium scan.
  • Gallium scans are non-specific. Both malignancy and infection, among other possibilities, can lead to increased uptake.
• It can be useful to correlate all of the images directly.

• Primary lymphoma in the neck is rare.
  • Lymphoma can involve:
    • The mandible and maxilla.
      • Non-descript lytic lesion.
      • Burkitt's lymphoma best known.
    • The oral cavity and oropharynx.
      • Rare.
      • Usually involve Waldeyer's ring of lymphoid tissue, esp. palatine tonsils.
    • The Nasal cavity and paranasal sinuses.
      • Usually non-Hodgkin's.
      • Seen with AIDS.
      • May mimic benign diseases, e.g., sinusitis.
    • The salivary glands, e.g., parotids..
    • The orbits.
      • Usually non-Hodgkins.
      • Usually part of systemic lymphoma.
      • Lymphoid tumors account for 10-15% of orbital masses.
      • Location and imaging characteristics may suggest diagnosis on CT and MR imaging.
    • Thyroid, thymus.

Teaching Points:

• Make sure to look at bones and soft tissues on chest x-rays.
• Make sure the trachea is in midline and is not compressed.

Ref: Valvassori, G.E., Mafee, M.F., Carter, B.L., Imaging of the Head and Neck, Thieme Medical Publishers, N.Y., 1995.

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