Mediastinal Adenopathy 60 of All Cases

The term mediastinal adenopathy includes the following nodal subgroups:

• Prevascular, aortopulmonary

• Paratracheal, subcarinal

• Posterior mediastinal.

Preauricular Occipital Post. Cervical Ant. Cervical Supraclavicular

Infraclavicular

Axilla

Epitrochlear

Portahepatic Celiac Paraaortic

Iliac

Inguinal Femoral

Preauricular Occipital Post. Cervical Ant. Cervical Supraclavicular

Infraclavicular

Axilla

Epitrochlear

Portahepatic Celiac Paraaortic

Iliac

Inguinal Femoral

Popliteal

Mediastinal Adenopathy

Waldeyer's Ring Nasopharynx Tonsil

Base of Tongue

Mediastinum

Spleen

Mesenteric

Fig. 15-1. Lymph node regions involved in Hodgkin disease. (From Thompson EI. Hodgkin's disease. In: Fernbach DJ, Vietti TJ, editors. Clinical Pediatric Oncology. 4th ed. St. Louis: Mosby, 1991;355-75, with permission.)

Waldeyer's Ring Nasopharynx Tonsil

Base of Tongue

Mediastinum

Spleen

Mesenteric

Popliteal

Fig. 15-1. Lymph node regions involved in Hodgkin disease. (From Thompson EI. Hodgkin's disease. In: Fernbach DJ, Vietti TJ, editors. Clinical Pediatric Oncology. 4th ed. St. Louis: Mosby, 1991;355-75, with permission.)

A mediastinal mass is defined as bulky (bulky mediastinal disease) on a posteroante-rior chest radiograph when the maximum width is equal to or greater than one third of the internal transverse diameter of the thorax at the level of the T5-6 interspace (mass/thoracic ratio >0.33). The chest radiograph should be taken with maximal inspiration in the upright position at a source-skin distance of 2 m. Relapse occurs more frequently in bulky mediastinal disease than in those with small masses. The principal sites of relapse are the margins of the radiation ports and adjacent organs.

The following nodes should be recorded separately:

• Hilar (bronchopulmonary) nodes are outside the mediastinum.

• Disease within the chest is usually in the anterior mediastinum (often at the site of thymus). The thymus may occasionally be the sole site of HD. This occurs as a variant of nodular sclerosing HD in younger patients.

• Internal mammary nodes are part of the lymphatic system of the chest wall and they drain the diaphragm.

• Paravertebral nodes, although in the posterior mediastinum, drain the chest wall and diaphragm.

• Anterior extension of a mediastinal mass into the sternum or chest wall or extension to lung or pericardium should be recorded as extranodal extension.

Table 15-6. Frequency of the Initial Sites of Involvement in Children with Hodgkin Disease

Site

Percentage

Neck (cervical, supraclavicular,

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