Malignant splenic lymphoma: sonographic patterns, diagnosis and follow-up

Six hundred and eighty patients with malignant lymphoma were studied by abdominal sonography during 1983 and 1993 at our institution. Abnormal splenic texture was noted in 101 patients (14,8%). Involvement of the spleen was confirmed histologically (n = 8), by sonographic follow-up (n = 82), and on the basis of the clinical course in the remaining patients. Of the 101 patients with splenic involvement, 34 had Hodgkin's disease, 38 had a low-grade non-Hodgkin's lymphoma and 29 a high-grade non-Hodgkin's lymphoma. Four different sonographic patterns were observed: (1) Diffuse involvement in 37 patients (pts) (36.6%). (2) Focal small nodular lesions in 39 pts (38.6%). (3) Focal large nodular lesions in 23 pts (22,7%). (4) 'Bulky, disease' in two pts (1.9%). All of the high-grade lymphomas showed either large nodular (15/29) or small nodular (14/29) lesions. The diffuse or small nodular pattern was seen predominantly in low-grade lymphomas (35/38) and in Hodgkin's disease (31/34).

A number of different patterns of splenic involvement in lymphoma can be demonstrated by ultrasound. Splenic sonographic patterns can be linked to histological lymphoma entities.