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Everything you need to know about Computed Tomography (CT) & CT Scanning

MDCT of the Spleen:  Lymphoma


Although lymphoma is the most common malignancy of the spleen, primary splenic lymphoma is rare accounting for only 1-2% of all forms of lymphoma. Other forms of splenic lymphoma include Hodgkin's and non-Hodgkin's.

Splenic involvement is more common with Non-Hodgkin's lymphoma than Hodgkins. Splenomegaly in individuals with non-Hodgkin lymphoma indicates involvement in most patients. Approximately 70% of patients with non-Hodgkin's lymphoma and splenic involvement have associated paraaortic adenopathy.
30% of patients with any form of lymphoma have splenic involvement without splenomegaly. In addition, in 30% of lymphoma patients with splenomegaly, the enlargement is not related to lymphomatous involvement.

The appearance of splenic lymphoma on contrast enhanced CT is variable. Usually this disease process remains within the borders of the splenic capsule, however occasionally local extension and invasion of adjacent structures occurs.
Lymphoma typically presents as homogenous splenomegaly. Lymphoma also develops as single or multiple masses (1-10cm), or milliary nodules mimicking the appearance of micro abscesses as typically seen in granulomatous diseases, fungal and pyogenic abscesses.

Solid masses are another nonspecific finding in lymphoma and must be correlated with clinical context. The differential for splenic masses includes metastasis (especially melanoma, breast and lung), angiosarcoma, hamartoma and hemangioma. Necrosis of solid masses may simulate cystic lesions of the spleen such as cysts, pseudocysts, infarction and peliosis.




© 1999-2021 Elliot K. Fishman, MD, FACR. All rights reserved.