Carsten Bock (Halle)  

Viewable for logged on visitors (Log on)  

18 Years  

N/A  

Head-Brain and brain nerves  

unknown  

18 year-old patient with a second reoccurance of Hodgkin's disease. In the course of restaging, an MR examination of the head was done. No neurological symptoms. Multifocal reoccurance (various lymph node regions, liver, spine = Stage IV).  

A malignant lymphoma with Sternberg-Reed Giant cells as a histological characteristic. In the early stages, this is a local lymph node illness, but in further stages it is a systemic illness. Epidemiology: Incidence 3/100,000. m:w - 3:2. Peak age: 30-60 years. Classification can be divided into 4 subtypes (nodular-sclerosing, mixed, lymphocyte rich, lymphocyte poor), where the nodular-sclerosing for is most common in younger patients.
Etiology is unknown.
Seeding is initially lymphogenic, but later it can be hematogenic or continuous. Staging occurs upon the clinical signs (Ann-Arbor). Stage IV corresponds to a disseminated form.  

<- view MRI 1

MRI 1: T1-weighted coronal image after contrast and before treatment: Obvious widening (about 1 cm) and pathologic contrast enhancement of the meningeal structures located parietally on both sides. MR-morohologically, one cannot distinguish between a dural or a leptomeningeal affliction, however the smooth contours intracerebrally and the absence of contrast in the sulci point to a dural infiltration.







<- view MRI 2

MRI 2: T1-weighted image coronal after contrast: Following slice of Image 1.







<- view MRI 3

MRI 3: T1-weighted image coronal after contrast (slice position as in image 1) 12 days after chemotherapy. There is an obvious regression of the meningeal widening with unchanged contrast enhancement.







<- view MRI 4

MRI 4: T1-weighted image coronal after contrast. 12 days after chemotherapy. Neighboring slice as in Image 3, slice position as in the second image.




 

Expert's opinion  

Meningeal metastases (i.e. neuroblastoma), inflammatory changes, meningeomas (more centrally located, near the middle, solid).  

A brain infiltration in Hodgkin's disease is rare. Between 1954 and 1999 there have only been 48 cases reported. Stein and Lennert's autopsy statistics showed 5 percent of the patients with Hodgkin's disease had dural infiltration. The spreading to intracranial structures is suspected to be hematogenic.  

N/A  

N/A  

1. Medline:
Nakayama, H. et al.
Brain Involvement in Hodgkin´s Disease: Case Report and Review of the Literature.
Radiation Medicine: Vol. 18 No. 3, 205208 p.p., 2000.

2. Medline:
Eder, M., P. Gedigk
Lehrbuch der Allgemeinen Pathologie und der Pathologischen Anatomie
Springer 1986, 32. Auflage S. 430-434.

3. Medline:
AWMF online - Leitlinie Pädiatrische Onkologie/Hämatologie: M. Hodgkin.  

Hodgkin's disease, meningeal participation, meningeal spread, child, childhood, pediatric radiology  

Carsten Bock. Meningeal spread in Hodgkin's disease. PedRad [serial online] vol 2, no. 12.
URL: www.PedRad.info/?search=20021217091236