Spontaneous extensive necrosis in non-Hodgkin lymphoma: Prevalence and clinical significance

Purpose: We studied the prevalence of spontaneous extensive necrosis in the nodes of patients with non-Hodgkin lymphomas and assessed the clinical sig nificance of this finding. Method: CT and MRI performed before initiation of radiation or chemotherapy were reviewed in 60 consecutive patients with non-Hodgkin lymphomas to eva luate the presence or absence of spontaneous extensive necrosis in the lymp homatous nodes. The results were correlated with histopathologic grading, s tages of lymphomas. maximal axial diameters of the lesions, International P rognostic Index (IPI), age, and serum lactate dehydrogenase (LDH) levels. W e then performed Kaplan-Meier analysis of disease-free survival using each factor. Results: Extensive necrotic nodes that appeared as rim-enhanced masses on e nhanced CT or MR images were found in 15 patients (25%). of whom 10 patient s had pathologic verification. The patients with necrosis had significantly higher stages (Stage ii or higher), greater IPI (IPI of greater than or eq ual to2), and higher serum LDH levels than those without necrosis (p = 0.00 1, p = 0.005, and p = 0.005, respectively). With the Kaplan-Meier method, a statistically significant difference was noted for serum LDH levels (p = 0 .015) and IPI (p = 0.021) but not for extensive necrosis (p = 0.600). Conclusion: Spontaneous extensive necrosis in lymphomatous nodes is not a r are event. This finding may have a prognostic significance for patients wit h non-Hodgkin lymphomas.