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The article discusses the diagnosis and investigation of patients with mantle cell lymphoma (MCL. Topics covered include the latest information on molecular pathology, the use of positron emission tomography/computed tomography (PET/CT) scanning in staging and response assessment, and biological prognostic factors of MCL.

Positron emission tomography-computed tomography (PET-CT) scanning has been shown to be more sensitive than bone marrow biopsy (BMB) in detecting bone marrow involvement (BMI) in classical Hodgkin lymphoma (cHL). In this 5-year retrospective series, 93 (54%) of all new cases of cHL were staged using PET-CT and BMB. PET-CT identified focal bone marrow uptake in 17/93 (18.3%), whilst only five of these (29.4%) were confirmed by BMB. Abnormal pelvic uptake was seen on PET-CT in these five cases. The other 12 cases were missed, giving BMB a sensitivity of 29.4% and a specificity of 100%. PET-CT upstaged 9.7% of patients compared to CT alone. BMB upstaged only one patient; however, this patient was already stage IV on PET-CT. BMB did not alter clinical management in any case. Bone positivity on PET-CT appeared to correlate with anemia, raised lactate dehydrogenase (LDH) and B symptoms. BMB has little or nothing to offer staging cHL in the PET-CT era. [ABSTRACT FROM AUTHOR]

GLO:1XW/01may20:bjh16464-fig-0001.jpg PHOTO (COLOR): . gl A 32-year-old male with a history of stage 1A nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) treated four years previously with radiotherapy presented with weight loss. Contrast computed tomography (CT) of neck, thorax, abdomen and pelvis demonstrated widespread small-volume lymphadenopathy and 17-cm splenomegaly. Bone marrow trephine biopsy sections showed a hypercellular marrow with numerous large paratrabecular lymphoid aggregates. [Extracted from the article]

Contrast magnetic resonance imaging (MRI) of brain and spinal cord demonstrated abnormal thickening and leptomeningeal enhancement of all visible cranial nerves, most striking in cranial nerves III (top left) and V (top right). Whilst leptomeningeal involvement can occur synchronously with primary central nervous system lymphoma, or as a feature of relapsed systemic lymphoma, isolated primary leptomeningeal lymphoma with no parenchymal lesions is extremely rare. MRI with contrast is often the only imaging modality that demonstrates meningeal enhancement and should be used in combination with CSF analysis to confirm the diagnosis. [Extracted from the article]

The article discusses the role of positron emission tomography (PET) in the management of Hodgkin lymphoma (HL).