Splenic lesions in Hodgkin's and non-Hodgkin's lymphomas. An ultrasonographic study

Objective: To reassess, in patients with lymphoma, the prevalence of splenic involvement by the disease, the ultrasound findings and the correlations with the histological data. Methods: A total of 342 consecutive patients, 56 with Hodgkin's (HL) and 286 with non-Hodgkin's lymphoma (NHL), were submitted to abdominal ultrasonography (US). The US-detected lymphomatous lesions were divided into: (1) small (less than 1 cm) and diffuse, producing a pattern of parenchymal infiltration; (2) focal. In the latter, the US patterns and the number and size of the lesions were registered. The lymphomatous nature of the splenic lesions was proved pathologically or by follow-up. Results: Fifty-four of the 342 patients showed splenic lesions; there were 9 56 patients with HL (16.1%) and 45 286 with NHL (15.7%); most of the lesions occurred at the initial staging and advanced stages of the diseases. Lesions of the diffuse type were found in 33% of the patients, both in HL and NHL; 67% of the patients had nodular lesions. Of the 54 spleens involved, 14 (26%) were normal-sized. In NHLs, the diffuse type lesions occurred mostly in low/intermediate grade and the nodular type in intermediate/high grade diseases. In total, 50% of all the nodular lesions were single and 50% were larger than 3 cm. In 67% of cases for HL and in 73% for NHL, the lesions were hypoechoic. Conclusions: US may reliably detect splenic involvement from lymphoma only if a modification of echo-texture is produced, as the size of the spleen is an insufficient criterion. The overall prevalence of splenic lesions in our series was 15.8%; it was higher than those previously reported. Lymphomatous lesions were confirmed to be mostly hypoechoic; only the correlations between diffuse lesions and low/intermediate grade NHLs and between nodular lesions and intermediate/high grade NHLs were confirmed.