Role Of Radiology in Gastrointestinal Lymphoma

DEFINITION
Lymphoma Is A Type Of Cancer That Arises In the Immune Cells Called As Lymphocytes.

Extra nodal Lymphoma Is Term Used To Describe Lymphomas Occuring Outside The Lymphatic Tissues.

INTRODUCTION
Distinct group of lymphoma that primarily arises in lymphoid tissue of the bowel rather than in lymph nodes

G I lymphoma may either represent secondary involvement by systemic disease or primary malignancy confined to the GI tract
GIT-lymphoid Elements Seen In The Lamina Propria and Sub Mucosa Secondary GI Involvement Is Common Primary Lymphomas Involve Only One Site

Five Criteria Put Forth By Dawson et al To Diagnose Primary GI Lymphomas

No Palpable Superficial Lymph Nodes

Normal CXR
WBC Count are Normal At Laparotomy Alimentary Tract Is Involved With Lymph node Involvement if Any confined to the drainage area of gut involved No Spleen Or Liver Involvement Advanced Stages Mimic Secondary GI Lymphoma

Gastrointestinal Lymphoma
Most Commonly Non-hodgkin Lymphomas That Are High Grade Large Cell Or Immunoblastic Cell Types Burkitt More Common In Pediatric Patients Most Common Symptoms: Abdominal Pain, Weight Loss, fever, Anemia T-cell Lymphoma If In GIT Occurs In Small Bowel (64%)esp.Duodenum+jejunum.

Oesophagus
Esophagus: Least common site within GI tract Accounts for only about 1% of all cases Usually non-Hodgkin & less commonly Hodgkin Patients almost always have generalized lymphoma Primary esophageal lymphoma seen in AIDS cases

Imaging
Usually contiguous spread from gastric cardia/fundus to distal esophagus Polypoid or ulcerated mass or infiltrating stricture Submucosal infiltration (less common) Enlarged, tortuous longitudinal folds mimicking varices Diagnosis: Endoscopy with deep esophageal biopsy

MULTIPLE ESOPHAGEAL NODULES

Gastric lymphoma
gastric lymphoma represents the most common site of extra nodal lymphoma, accounting for 25% of all such lymphomas, 50% of all gastrointestinal lymphomas, but comprise only 1-5% of all gastric malignancies . Typically primary gastric lymphoma occurs in adults in the 6th decade of life, without gender predilection. Secondary gastric lymphoma matches the demographics of the underlying lymphoma.

Pathology
Three distinct types of gastric lymphoma are recognized :
low-grade MALT lymphoma : 60% of all primary gastric lymphomas primary sporadic lymphoma : vast majority are B-cell nonHodgkins lymphoma secondary involvement of the stomach by systemic lymphoma (usually high grade) Mucosa-associated lymphoid tissue (MALT) lymphoma and are strongly associated with Helicobacter pylori (85 - 98% of cases). These are low-grade lymphomas and may regress following treatment of Helicobacter infection .

Radiographic features Gastric lymphoma Fluoroscopy : Barium meal

Appearances vary from normal, to grossly abnormal. Possible appearances include:
bull's eye appearance due to central ulceration filling defects thickened gastric rugae linitis plastica

Computed tomography
Typically gastric lymphomas demonstrate marked thickening of the stomach wall (2-4cm) with extensive lateral extension of the tumour (i.e. along the wall of the stomach) representing submucosal spread.

Submucosal

spread may

Encompasses the majority of the stomach giving a linitis plastica appearance.

Can extend across the pylorus into the duodenum and superiorly into the oesophagus.
uncommon for lymphoma to result in gastric outlet obstruction

UPPER GI SERIES SHOWS MASSIVE NODULAR THICKENINGS OF GASTRIC WALL/FOLDS; LYMPHOMA

PERSISTENT COLLECTION OF CONTRAST WITH MUCOSAL ULCERATION

LINITIS PLASTICASMALL NON DISTENSIBLE STOMACH

BULLS EYE LESION

THICKENED GASTRIC FOLDS

GI lymphoma staging
I: Tumor confined to bowel wall
II: Limited nodal spread to local nodes III: Widespread nodal mets IV: Spread to bone marrow, solid viscera, liver

Small bowl
1/5 of all small bowel malignancies. Most common malignant small bowel tumor. Multiple sites involvmentin1/5. Most common cause of INTUSSUSEPTION in children>6yrs

 Location ileum(51%)

jejunum(47%)
duodenum(2%)

Site
payer patches

 Radiographic findings;
Nodular pattern Single mass Infiltrating pattern Exophytic Mesenteric/retroperitoneal Adenopathy

Duodenal Lymphoma---Bulky Soft Tissue Mass Infiltrating Submucosa

Small Intestinal Mass

Colon
Less Comonly Involved Than Stomach/Small Bowel 1.5% Of All Abdominal Lymphomas Location Cecum Mostly Presentation Single mass>diffuse infiltrating>polypoid Paradoxical dilatation Gross mural circumferential thickening Massive regional+distantmesenteric+retroperitoneum adenopathy.

APPENDICULAR LYMPHOMA--- SOFT TISSUE MASS NEAR TIP OF CAECUM

Mesentry And Omentum

Infiltration and thickenining of mesentry
Omental caking Nodular or strand like soft tissue density

Calcified foci
Rounded mass

Peritoneal And Omental Mass

Small Intestine .. Fold Thickening Luminal Narrowing

Thickened Mucosal Folds With Ulceration

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