title: Spontaneous extensive necrosis in non-Hodgkin lymphoma: prevalence and clinical significance.
abstract: OBJECTIVE
  We studied the prevalence of spontaneous extensive necrosis in the nodes of patients with non-Hodgkin lymphomas and assessed the clinical significance of this finding.
  
  
  METHODS
  CT and MRI performed before initiation of radiation or chemotherapy were reviewed in 60 consecutive patients with non-Hodgkin lymphomas to evaluate the presence or absence of spontaneous extensive necrosis in the lymphomatous nodes. The results were correlated with histopathologic grading, stages of lymphomas, maximal axial diameters of the lesions, International Prognostic Index (IPI), age, and serum lactate dehydrogenase (LDH) levels. We then performed Kaplan-Meier analysis of disease-free survival using each factor.
  
  
  RESULTS
  Extensive necrotic nodes that appeared as rim-enhanced masses on enhanced CT or MR images were found in 15 patients (25%), of whom 10 patients had pathologic verification. The patients with necrosis had significantly higher stages (Stage II or higher), greater IPI (IPI of > or = 2), and higher serum LDH levels than those without necrosis (p = 0.001, 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).
  
  
  CONCLUSIONS
  Spontaneous extensive necrosis in lymphomatous nodes is not a rare event. This finding may have a prognostic significance for patients with non-Hodgkin lymphomas.
authors.affiliation: Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Saito
authors.forename: S
authors.initials: S
authors.lastname: Takashima
authors.forename: F
authors.initials: F
authors.lastname: Takayama
authors.forename: S
authors.initials: S
authors.lastname: Kawakami
authors.forename: M
authors.initials: M
authors.lastname: Momose
authors.forename: T
authors.initials: T
authors.lastname: Matsushita
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008228:Lymphoma, Non-Hodgkin / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed