Hodgkin's and non-Hodgkin's lymphoma of the head and neck

Objectives/Hypothesis. Lymphomas are a frequent cause of malignant lymphade nopathy in the head and neck. This study was performed to evaluate the head and neck manifestations of lymphomas and to emphasize the different presen tations of Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL). Study D esign: Retrospective review. Methods. A retrospective review was made of al l cases of lymphomas involving the head and neck at Marshfield Clinic (Mars hfield, WI) between 1988 and 1996. Specifically, the clinical presentations , staging, and prognosis for HD and NHL with head and neck involvement were sought. Results: Three hundred eleven patients were included in the study, 76 with HD and 235 with NHL. The median age at diagnosis for patients with HD was 27.7 years, and for patients with NHL, 67.2 years. This difference was highly significant (P < .001). No significant difference in gender was noted, with male patients occurring in 59% with HD and 49% with NHL (P = .1 35). Extranodal involvement including the oral cavity, oropharynx, nasophar ynx, paranasal sinuses, and larynx occurred with HD in 3 patients (4%) and with NHL in 54 patients (23% P < .001). Cervical adenopathy consisted of a single node in 24% of patients with HD and 33% of those with NHL (no signif icant difference, P = .236). The difference in mediastinal nodal involvemen t was highly significant, occurring in 65% of patients with HD and 38% of p atients with NHL (P < .001). Abdominal nodes occurred in 20% of cases of HD and 45% of cases of NHL (P < .001). A significant difference in constituti onal symptoms was noted with 41% of cases in HD and 27%, of cases in NHL (P = .020). For the percentage of patients with stage IV disease, there was a highly significant difference by diagnosis with 10% in HD and 36% in NHL ( P < .001). The median follow-up time was 51 months, and 12% of patients wit h HD and 41% of patients with NHL died of their disease. Both the overall s urvival and survival from death attributable to disease were significantly better for HD (P < .001). Conclusions. Hodgkin's disease presents at a youn ger age and is less common than NHL. Cervical lymphadenopathy is the most c ommon head and neck presentation for both diseases. Associated mediastinal adenopathy was more common with HD, and abdominal adenopathy with NHL. Cons titutional symptoms were more common with HD. More advanced disease with a decreased overall survival was seen with NHL.