Involvement of abdominal and pelvic lymph nodes in non-Hodgkin lymphoma: the nodal distribution in Chinese patients

Abstract

Objective

To study the distribution of abdominal and pelvic lymphadenopathy in non-Hodgkin lymphoma (NHL) in Chinese patients.

Methods

CT images of 241 NHL patients with abdominal and/or pelvic lymphadenopathy were reviewed. Among them, clinical and image data from 96 patients fulfilled the requirements for the analysis: 1. Abdominal and/ or pelvic lymphadenopathy detected by CT in untreated patients (n=74). 2. Recurrent patients: new lesions in abdominal or pelvic lymph nodes who never had any nodular lesion by previous abdominal and/or pelvic CT (n = 14). 3. Treated patients who did not have abdominal and/or pelvic CT previously, showed regression of initial disease for at least 6 months after chemotherapy and subsequently showed abdominal and/or pelvic lymphadenopathy (n=8). According to the Clinical Schema for Lymphoid Tissue, these patients were divided into 3 histologic subtypes: indolent (IL; n=31), aggressive (AL; n=61) and very aggressive (VAL; n=2) lymphoma. The remaining 2 cases were unclassified lymphoma (UCL). Both abdominal and pelvic CT scans were undertaken in 46 patients, abdominal CT only in 47 patients and pelvic CT only in 3 patients. Enhanced CT was obtained in 80 patients. The anatomic sites involved were designated as retroperitoneal (ie. paraaortic), mesenteric, abdominal (i.e. celiac, paracardiac, gastrohepatic and hepatic hilum, etc.), retrocrural, subdiaphragmatic, common iliac, internal iliac, external iliac and inguinal nodes respectively.

Results

The lesions located in the retroperitoneum were most common for IL and AL, the incidences being 83.3% (18/25) and 83.1% (49/59) respectively, results being similar. Among those, lymphadenopathy distributed mainly in the retroperitoneum, superior and inferior renal hila, with an incidence of 72.0% (18/25) in IL and 67.3% (33/49) in AL. Pelvic lymphadenopathy came next, with the overall incidence of 41.9% (126/301), 57.5% (50/87) in IL and 35.5% (76/214) in AL respectively. Mesenteric lymph nodes stood third with the overall incidence of 37.1 % (33/89), 43.3% (13/30) in IL and 33.9% (20/59) in AL. Statistical analysis showed that external iliac lymph node involvement to be more common in IL than in AL (P<0.05), while comparisons of other groups showed no statistical significance.

Conclusion

For Chinese NHL patients, retroperitoneal lymph nodes were mostly involved, followed by iliac and mesenteric lymphadenopathy, which was different from that of the Western countries. The involved retroperitoneal lymph nodes in NHL of Chinese patients were predominantly located in the superior and inferior renal hilum.