Imaging Pearls ❯ Colon ❯ Lymphoma
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- “Gastrointestinal (GI) lymphoma accounts for 5–20% of extranodal lymphomas: the stomach is the most common site, followed by small intestine (ileum (60–65%), jejunum (20%−25%), and duodenum (6%–8%) and then colorectal lymphomas (6–12%)). GI lymphomas most commonly occur around the sixth decade of life and, although rare in childhood, they are the most common GI tumours in this age.”
Radiological Features of Gastrointestinal Lymphoma
Giuseppe Lo Re et al.
Gastroenterology Research and Practice Volume 2016, Article ID 2498143 - “Risk factors implicated in the pathogenesis of GI lymphoma are some infections due to Helicobacter pylori, human immunodeficiency virus infection, Campylobacter jejuni, Epstein-Barr virus, hepatitis B virus, human T-cellmlymphotropic virus-1, and some inflammatory conditions asmceliac disease, inflammatory bowel disease, atrophic gastritis, and parasitic infection.”
Radiological Features of Gastrointestinal Lymphoma
Giuseppe Lo Re et al.
Gastroenterology Research and Practice Volume 2016, Article ID 2498143 - “Clinical findings are not specific and this causes a delay in the diagnosis.The most common symptoms are epigastric pain, weight loss, and anorexia; nausea and vomiting in case of gastric lymphoma is uncommon, except in the later stage of the disease. Other symptoms encountered in these patients are GI bleeding and the presence of an abdominal mass and bowel perforation, mainly in the small bowel.”
Radiological Features of Gastrointestinal Lymphoma
Giuseppe Lo Re et al.
Gastroenterology Research and Practice Volume 2016, Article ID 2498143 - “The majority of GI lymphomas are of B-cell origin, while just 8%–10% show a T-cell origin . Most low-grade B-cell GI lymphomas are of mucosa-associated lymphoid tissue (MALT) type, while enteropathy-associated T-cell lymphoma is the most common primary gastrointestinal T-cell lymphoma. GI lymphomas represent a heterogeneous group of entities originating from different cell lineage, with lymphoid cell at different stage of development, and with different biologic behaviour. Certain histological subtypes most commonly occur in a precise location as MALT lymphoma in stomach, mantle cell lymphoma in terminal ileum, jejunum, and colon, enteropathy-associated T-cell lymphoma injejunum, and follicular lymphoma in duodenum .”
Radiological Features of Gastrointestinal Lymphoma
Giuseppe Lo Re et al.
Gastroenterology Research and Practice Volume 2016, Article ID 2498143 - “Primary esophageal lymphomas account for less than 1% in all primary GI lymphomas, while usually result from lymph node metastasis of the lymphomas from the cervical or mediastinal region. Both findings on barium studies, as irregular filling defects, and on CT, as thickened esophageal wall with narrowed lumen, are nonspecific and mimic esophageal adenocarcinoma. However, CT may be useful to differentiate primary esophageal lymphoma from lymph node involvements in the cervical or mediastinal regions, in staging of the disease and in evaluating response to therapy.”
Radiological Features of Gastrointestinal Lymphoma
Giuseppe Lo Re et al.
Gastroenterology Research and Practice Volume 2016, Article ID 2498143 - “The most common CT patterns of gastric lymphoma are the presence of diffuse or segmental wall thickening of 2–5 cm with low contrast enhancement and extensive lateral extension of the tumour due to submucosal spread; moreover, CT can assess the presence of lymphadenopathies. Less commonly, gastric lymphoma may present on CT as a polypoidal mass, an ulcerative lesion, or a mucosal nodularity. Considering the CT features of lymphoma, in low-grade ones there is less severe gastric wall thickening than in highgrade lymphoma, and abdominal lymphadenopathy is less common.The absence of abnormality or the presence of just minimal gastric wall thickening or a shallow lesion at CT suggests low-grade MALT lymphoma; yet, CT is of limited value in its diagnosis. A greater thickening may indicate transformation to a higher grade lymphoma.”
Radiological Features of Gastrointestinal Lymphoma
Giuseppe Lo Re et al.
Gastroenterology Research and Practice Volume 2016, Article ID 2498143 - “CT is particularly useful both for staging and in the follow-up after surgery or chemoradiotherapy.Nowadays,CT allows the evaluation of wall thickness, mesenteric vasculature, and any associated extramural findings. Small bowel CT, or entero-CT, performed through a multislice CT scanner has led to considerable advances in the detection and staging of intestinal diseases.The advantage of this technique lies in its panoramic view, which allows the evaluation of the intestinal wall thickness, the degree of bowel distension, and the circular folds. Yet, ileal loops and also those of the deep pelvis, the mesentery, the surrounding adipose tissue, and other abdominal organs are studied.”
Radiological Features of Gastrointestinal Lymphoma
Giuseppe Lo Re et al.
Gastroenterology Research and Practice Volume 2016, Article ID 2498143 - The most common CT/MR patterns of small bowel lymphoma are:
(i) Polypoid/nodular pattern.
(ii) Infiltrative pattern.
(iii) Aneurismal pattern.
(iv) Exophytic mass.
(v) Stenosing mass (rare).
Radiological Features of Gastrointestinal Lymphoma
Giuseppe Lo Re et al.
Gastroenterology Research and Practice Volume 2016, Article ID 2498143 - “The polypoid pattern is characterized by the presence of a solid nodule, with a homogeneous signal density/intensity, that develops in the submucosa and protrudes into the lumen appearing as a polypoid mass. There is no wall thickening and/or lymph adenopathy and the mucosa is intact. This mass may cause intussusception. The infiltrative form is characterized by segmental symmetrical or slightly asymmetrical infiltrating lesions with a medium diameter of 1.5 cm and 2 cm, associated with mild circumferential thickening of the small bowel wall. Usually, the infiltrative lesions show ill-defined margins and a homogeneous contrast enhancement; the latter may rarely be inhomogeneous because of the presence of hypodense/ hypointense areas due to development of necrosis and/or ischemia in the context of the lesion. These lesions may extend to the whole bowel thickness, from the endoluminal mucosa to the tunica serosa.The length of the thickened small bowel segment is variable.”
Radiological Features of Gastrointestinal Lymphoma
Giuseppe Lo Re et al.
Gastroenterology Research and Practice Volume 2016, Article ID 2498143 - “The aneurismal pattern (diameter of dilatation of the lumen over 4 cm), firstly diagnosed byCupps et al. in 1969, represents 31% of small bowel lymphomas. It usually coexists with the infiltrative form since it can represent its natural evolution. Several factors are responsible for the aneurismal dilation secondary to infiltrative growth of neoplastic lesion, as a progressive destruction of myenteric plexus, destruction of muscle layers with stretching of the muscle fibers, and loss of contractile cells; on the other hand, the infiltration of arterial and lymphatic vessels determines anoxia and necrosis within the lesion. According to some authors, this tumour necrosis could lead to cavitation and be also responsible for the aneurismal dilatation.”
Radiological Features of Gastrointestinal Lymphoma
Giuseppe Lo Re et al.
Gastroenterology Research and Practice Volume 2016, Article ID 2498143 - “Differential diagnosis includes all inflammatory, neoplastic, and metastatic lesions involving the small bowel. Primary carcinoma, metastases (especially those from melanoma and renal cancer), and the intestinal leiomyosarcoma are characterized by large necrotic/colliquative cavitations. In rare cases, inflammatory conditions, such as Crohn’s disease and intestinal tuberculosis, have to be differentiated: the significant thickening of the bowel wall (greater than 2 cm), the presence of lymphomatous nodules, and the coexistence of perivisceral multiple lymph nodes are CT features that are suggestive for a lymphoproliferative process.”
Radiological Features of Gastrointestinal Lymphoma
Giuseppe Lo Re et al.
Gastroenterology Research and Practice Volume 2016, Article ID 2498143 - “Primary lymphoma of the large bowel accounts for 0.4% of all tumours of the colon, and colorectal lymphomas constitute 6%–12% of gastrointestinal lymphomas.The cecum and rectum are most commonly affected parts compared to other tracts of the large bowel. Primary large bowel lymphoma may appear as localized, large, extraluminal masses or constricting simulating annular-type carcinomas and may present with different radiological patterns that are often quite similar to other large bowel tumours or inflammatory diseases, thus leading to a difficult differential diagnosis These patterns include bulky polypoidal mass, focal infiltrative tumour, and aneurismal dilatation.”
Radiological Features of Gastrointestinal Lymphoma
Giuseppe Lo Re et al.
Gastroenterology Research and Practice Volume 2016, Article ID 2498143 - “Colonic lymphoma usually presents with larger lesions and involves a longer segment compared to adenocarcinoma; moreover, colonic lymphoma is usually located near the ileocaecal valve and grows into the terminal ileum, not invading or obstructing neighbouring viscera.”
Radiological Features of Gastrointestinal Lymphoma
Giuseppe Lo Re et al.
Gastroenterology Research and Practice Volume 2016, Article ID 2498143 - “Thanks to CT it is possible to study not only the GI tract using enterography technique, but also local and distant lymph nodes and other thoracic and abdominal organs that can be affected also by the disease, thus allowing an imaging staging of the disease according to the classification of the Consensus Conference of Lugano. The role of CT is also considered pivotal in the evaluation of complications of the disease, as perforation, fistulisation, and obstruction, and in the differential diagnosis with other neoplastic or inflammatory conditions, whichmay also coexist with the lymphoma. Lastly, CTmust be actually considered also the preferred technique for the evaluation of response to therapy when medical therapy with targeted therapy is used; in this case according to the used drug, the imaging appearance may be substantially different.”
Radiological Features of Gastrointestinal Lymphoma
Giuseppe Lo Re et al.
Gastroenterology Research and Practice Volume 2016, Article ID 2498143