Non-Hodgkin's lymphoma of the head and neck: CT evaluation of nodal and extranodal sites.

Forty-five patients with non-Hodgkin's lymphoma (NHL) of the extracranial head and neck who had undergone CT as part of their evaluation were reviewed to assess the impact of CT on clinical management. The sites of tumor deposition were subdivided by location: I, nodal; II, extranodal, lymphatic (Waldeyer's ring); and III, extranodal, extralymphatic (orbit, sinonasal, deep facial spaces, mandible, salivary gland, skin, and larynx). The CT appearance of NHL in each of the three locations was analyzed for characteristic CT signatures. Nodal NHL was suspected when CT showed multiple, large, homogeneous lymph nodes, often in unusual nodal chains of the head and neck. Extranodal, lymphatic NHL of Waldeyer's ring was indistinguishable from squamous cell carcinoma of this area unless synchronous tumor deposit in an extranodal, extralymphatic location was also present. When NHL was in nodes and/or Waldeyer's ring, CT-derived information was of limited clinical value since treatment was unfocused (chemotherapy and/or large-field radiotherapy). The CT appearances of extranodal, extralymphatic NHL was generally not distinguishable from other malignancies of these areas. However, CT-derived information regarding deep-tissue tumor size and extent was critical to planning the radiotherapy ports.