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History A 58-year-old otherwise healthy woman reported intermittent swelling of several years duration on the right side of her neck. She did not smoke or drink alcoholic beverages. Computed tomography (CT) of the neck was performed. The patient was lost to follow-up; however, 20 months after the original examination was performed, she presented again with continued gradual progression of swelling on the right side of her neck and new dysphagia. Repeat CT was performed at this time.

PURPOSE: To evaluate the usefulness of lymphangiography in the staging of Hodgkin disease. MATERIALS AND METHODS: The authors retrospectively evaluated the lymphangiograms of 39 previously untreated patients with Hodgkin disease (clinical stage, 1-2A). The patients had no evidence of bulky mediastinal nodal disease, and results of abdominal and pelvic computed tomographic examination were negative for parenchymal organ disease and retroperitoneal and mesenteric node involvement. The studies were officially interpreted as normal or abnormal. No attempt was made to differentiate benign reactive changes from tumor infiltration. All patients underwent confirmatory staging laparotomy. RESULTS: Of the 39 patients, 29 had normal lymphangiograms. All 29 had normal lymph nodes at laparotomy. Of the 10 patients with abnormal lymphangiograms, only two had malignant infiltration of lymph nodes at laparotomy. The other eight showed benign reactive hyperplasia. CONCLUSION: Lymphangiography has no place in the managemen...

Ultrasonography has proved a valuable tool for the detection of enlarged lymph nodes; however, differentiation between benign and malignant nodal disease remains a problem. High-frequency probes with improved spatial and contrast resolution display superficial nodes to advantage and also show the internal structure of the nodes. Ninety-four superficial nodes in patients with suspected nodal disease were examined by using 7.5-MHz probes to evaluate longitudinal-transverse diameter ratio (L/T), the central hilus, cortical widening, and size. Histologic diagnosis was obtained after sonographic examination in 73 nodes (five reactive nodes, 35 primary nodal malignancies, and 33 nodal metastases). The remaining 21 nodes regressed after either antibiotic or no therapy. Marked differences were observed among the proportions of benign and malignant nodes in terms of L/T, hilus, and cortex; the latter two structures, however, must be interpreted together. Eccentric cortical widening was seen in only malignant nodes. The distribution of nodal size was not significantly (P greater than .1) different for benign and malignant nodes. No differences were observed between primary and secondary nodal malignancies. The sonographic criteria evaluated in this study assist in the differentiation of benign from malignant superficial lymph nodes.

Xeroradiographic evaluation of the axillary lymph nodes permits differentiation of characteristic patterns, including normal nodes and those enlarged as the result of fatty infiltration, inflammation, metastases from a breast primary, or primary nodal disease such as lymphoma or hyperplasia. The author describes his experience with this technique in selected patients.

The superior intercostal veins define the pleural reflections of the caudad extent of the posterior junction line. They are paired structures which drain the first three intercostal spaces and join the azygous on the right and the accessory hemiazygous on the left. Because of their location posterior and lateral to the esophagus and trachea, their pleural reflections may be altered early in the course of a focal nodal disease of the posterior mediastinum.

Analysis of the results of radiotherapy in patients with non-Hodgkin's lymphomas revealed 26 who had localized diffuse histiocytic lymphoma characterized by a median survival of 13 months and a high risk of relapse within one year of treatment. In contrast, 34 patients with localized nodular mixed histiocytic-lymphocytic or nodular lymphocytic poorly differentiated lymphoma exhibited a median survival of 80 months and a pattern of continued late relapse. Patients with localized extralymphatic involvement associated with limited nodal disease behaved similarly to patients with lymphoma confined to limited nodal sites.

For a number of years at Memorial Hospital for Cancer and Allied Diseases, New York, inferior vena cavography has been found valuable in conjunction with lymphangiography and intravenous pyelography in study of retroperitoneal nodal disease, especially the lymphomas. Generally, however, we have been dissatisfied with the quality of our inferior vena cavograms as performed by technics currently in use. An improved technic has been developed, directed toward better visualization of the upper inferior vena cava. Material and Method Inferior vena cavography was performed 92 times in 90 patients. Three injections per examination were made whenever feasible for comparison of accepted technics with improvements. All were performed intravenously with the Seldinger catheterization method, using meglumine iothalamate 60 per cent, power injection, and anteroposterior and lateral projections. Pressure, volume, and rate of injection, filming rate and delay, exposure time, number, location and design of catheters, pati...

Fifty-eight selected cases of infradiaphragmatic non-Hodgkin's nodal and extranodal lymphomas are reviewed and divided into the following categories: nodal vs. extranodal; nodular vs. non-nodular; and abdominal vs. femoral. Good prognostic factors are nodal disease and nodular histology, the latter being of most significance. Field size is of equal importance to total dose. At least a third of all patients might have benefitted by diaphragm-to-femoral irradiation on initial presentation. Although total nodal irradiation could not be universally recommended in any category, whole abdominal irradiation to 2,000 rads with a boost to the primary disease is advised in both femoral and abdominal categories.

In 47 previously untreated patients with nasopharyngeal cancer, curative doses of linear accelerator radiation were administered. The absolute survival rate without clinical evidence of disease was 27/47 (58%). More deaths resulted from intercurrent disease and metastases (11 patients) than from persistent primary and/or regional nodal disease (9 patients). Aggressive therapy of clinically involved and uninvolved cervical node disease is supported by 76% (28/37) and 98% (38/39) control rates, respectively. Curative irradiation by a variety of techniques resulted in an average survival of three years after retreatment, with only one local tumor recurrence at death. Second primary tumors occurred in 6 of 58 patients (10%).

A prospective CT study of seventeen patients with metastatic cervical adenopathy from tumors at an unknown primary site, believed most likely to be in the upper aerodigestive tract, was performed. All patients had normal endoscopic examinations performed by an otolaryngologist before the CT study. CT suggested a primary site in ten cases, of which four were confirmed by surgery or biopsy. In four cases, CT did not identify a suspicious site and no primary site was identified during triple endoscopy, sometimes with blind biopsies. CT was able to suggest correct causes other than carcinoma in three cases and gave useful information about the extent of nodal disease. CT should be used as part of the routine evaluation of patients with this clinical problem. A diagnostic algorithm is suggested in which CT is integrated with modern endoscopic and aspiration cytologic techniques.

A total of 243 patients with squamous-cell carcinoma of the nasopharynx, tonsillar fossa, and base of the tongue were analyzed for frequency of distant metastases after tumor control had been achieved. Frequency of distant metastases did not increase with the size of the primary lesion. Patients with advanced nodal disease had a higher frequency of distant metastases at five years than did those with early nodal disease. The location of neck disease does not influence the frequency of distant metastases.