Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

MUSCULOSKELETAL
Year
: 2005  |  Volume : 15  |  Issue : 1  |  Page : 73--74

Extra-nodal manifestations of Hodgkin's disease


PV Shekar, R Pal, MK Diwedi, S Hiren, V Agarwal, R Aind 
 Department Of Radiodiagnosis, Jawaharlal Nehru Hospital And Research Centre, Sector-9, Bhilai (Chattisgarh)- 490009, India

Correspondence Address:
P V Shekar
Department Of Radiodiagnosis, Jawaharlal Nehru Hospital And Research Centre, Sector-9, Bhilai (Chattisgarh), Pin-490009.
India




How to cite this article:
Shekar P V, Pal R, Diwedi M K, Hiren S, Agarwal V, Aind R. Extra-nodal manifestations of Hodgkin's disease.Indian J Radiol Imaging 2005;15:73-74


How to cite this URL:
Shekar P V, Pal R, Diwedi M K, Hiren S, Agarwal V, Aind R. Extra-nodal manifestations of Hodgkin's disease. Indian J Radiol Imaging [serial online] 2005 [cited 2019 Jun 25 ];15:73-74
Available from: http://www.ijri.org/text.asp?2005/15/1/73/28750


Full Text

Twenty-three years old man presented with fever since two months and difficulty in walking since fifteen days.

On examination he was febrile, anemic, having sternal tenderness, inguinal lymphadenopathy. On perabdominal examination Spleen and Liver were palpable. Blood and Urine examination found negative for 'M' band and B. J. proteins.

 IMAGING FINDINGS



Chest radiograph shows bilateral homogeneously hazy lung fields with few nodular opacity in lung parenchyma.

Plain Dorso-lumbar spine Radiograph shows wedging of D-6 vertebra, with maintained disc space. No significant Para spinal soft tissue shadowing seen.

Pelvis radiograph shows multiple mixed density lesions involving both the iliac wings and proximal femur with wide zone of transition. Hip Joint space and margin normal.

Conventional myelogram shows extradural type of filling defect pushing the contrast column posteriorly causing partial obstruction to flow of contrast column at D-6 level CT myelography has shown lytic lesion in D-6 vertebra causing destruction of cancellous bone with breech in cortex. End plates were maintained. Extradural soft tissue mass noted in spinal canal causing displacement and compression of cord.

CT Thorax shows bilateral nodular opacities with diffuse non segmental pneumonia like infiltrates. No mediastinal Lymphadenopathy is noted.

Evidence of lytic lesion noted in sternum, rib and right scapula with soft tissue component. Histopathological report shown polymorphic cell population consisting of transformed immunoblast and few plasma cells interspersed between these polymorphic cell populations of epitheloid cells noted. All features suggesting Hodgkin's disease.

 DISCUSSION



Lymphomas are diseases of lymphatic and reticuloendothelial System. Involvement of bone by any criteria indicates extensive or late disease.[1]

Differences in radiological appearance and management make it important for the radiologist to differentiate lymphomas from carcinomatous metastasis. [1]

Radiographic Bone involvement seen in 20% of patients with Hodgkin's disease, appearing in 4% as initial presentation [2],[3]

About three quarters of the patient present between the ages of 20 to 30 years. [3]

Axial skeleton more commonly involved (77%) than appendicular skeleton (23%). [4]. Lesions may be polyostotic (66%) or solitary (33%)[5].

Radiographic lesions range from small area of destruction to large permeative lesion. The edge is usually wide and ill defined [4]. Lesions found may be lytic, sclerotic or mixed. Lytic and mixed type of lesion accounts for 90% of lesion. [3]

Vertebral lesions are common in dorsal spine and lumbar Spine, least common in cervical spine. Osteolysis is the rule sometime ivory vertebra may be seen. [6]

In case of involvement of spine, vertebral collapse takes place early. Disc spaces are usually well maintained. Preservation of the cortex of the vertebral body is the feature favoring Hodgkin's disease. [3]

In long bones sites of predilection are red marrow containing bones, proximal femora and they are more often are lytic type. [3]

Sternum is again site of common involvement lesion usually is of lytic type. Skull, ribs scapula are also some times affected with soft tissue involvement. [7]

Radiographic involvement of lungs is quite common in the absence of mediastinal involvement. Usually seen in the form of consolidation type of lesion with air bronchograms within. [4]

References

1Grainger Allison's Diagnostic Radiology: edi-3, vol 2 skeletal system, myeloproliferative and similar disorders, 1999; 1700-01
2Vieta IO, Fridel hl, vaver LF: A survey of Hodgkin's disease and Lymph sarcoma in bone, Radiology 1942;39:1-14.
3Bramstein EM, Hodgkin's disease of bone: radiographic correlation with histologic classification, Radiology 1980; 137:643-646.
4Radiological clinics of North America, july-1990, 28.4, 859-863
5Ngan H, Preston BJ: NHL presenting with osseous lesions skeletal Radiol, 1975;26:351-356,
6Jaun M. Taveras, Joseph T. Ferrucci, Radiology, Diagnosis-Imaging-Intervention, 1986, vol-5, chap-96, 3-4
7DavidSutton, Text Book of Radiology and Imaging, edi-6; 1998, vol-1, Bones and Joint, 212-213