Hodgkin lymphoma

Case contributed by Andrew Kirby

Presentation

Tender supraclavicular neck swelling. Associated itch and weight loss.

Patient Data

Age: 13 years
Gender: Male
ultrasound

Multiple abnormal lymph nodes. Bulky, spherical shape, loss of normal cortical architecture and fatty hilum. Appearances are concerning for lymphoma.

x_ray

Multiple hilar lymph nodes and widening of the superior mediastinum, indicating likely involvement of these nodal stations.

ultrasound

Enlarged spleen contains multiple irregular, heterogeneous lesions suspicious for splenic involvement (below diaphragm). Abdomen and pelvis otherwise normal.

ct

Cervical, supraclavicular, mediastinal and hilar nodes are abnormal. Focal lesions within lung and spleen. Stage IVb.

mri

Cervical, supraclavicular, mediastinal and hilar nodes are abnormal. Focal lesions within lung and spleen. Stage IVb.

No additional lesion.

Nuclear medicine

PET-CT performed at 3 months.

FDG uptake at mediastinal and hilar nodes is similar to background mediastinum.

Lung nodules have reduced in size and have FDG uptake below mediastinum.

Normal appearance of liver and spleen.

Deauville score = 2

Case Discussion

A typical example of Hodgkin lymphoma (confirmed at lymph node biopsy shortly after presentation) with complete PET response to treatment at 3 months. Some residual 'bulky' nodes remain present at 18 months which are stable.

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