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Everything you need to know about Computed Tomography (CT) & CT Scanning

Small Bowel: Lymphoma Imaging Pearls - Educational Tools | CT Scanning | CT Imaging | CT Scan Protocols - CTisus
Imaging Pearls ❯ Small Bowel ❯ Lymphoma

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  • “B cell lymphoma, especially diffuse large B-cell lymphoma (DLBL), is the most common type of primary gastrointestinal lymphoma, of which primary non-Hodgkin lymphoma (NHL) of gastrointestinal tract accounts for 10–15% of NHLs; the most commonly involved site of DLBL is the ileum of the small bowel . T-cell lymphoma, which occurs much less frequently than B-cell lymphoma, tends to develop in the proximal portion of the small bowel, such as the jejunum or proximal ileum.”
    Tumors of the jejunum and ileum: a pattern‐based imaging approach on CT
    Kim SW et al.
    Abdominal Radiology (2019) 44:2337–2345
  • “Perforation is observed in 16–33% of patients with T-cell lymphoma at the time of clinical presentation, and this is attributed to transmural involvement and necrosis. Additionally, T-cell lymphoma is more likely to be multifocal disease than is B-cell lymphoma. In patients with celiac disease, there is an increased incidence of T-cell lymphoma in the small bowel, especially jejunum.”
    Tumors of the jejunum and ileum: a pattern‐based imaging approach on CT
    Kim SW et al.
    Abdominal Radiology (2019) 44:2337–2345
  • “B cell lymphoma, especially diffuse large B-cell lymphoma (DLBL), is the most common type of primary gastrointestinal lymphoma, of which primary non-Hodgkin lymphoma (NHL) of gastrointestinal tract accounts for 10–15% of NHLs; the most commonly involved site of DLBL is the ileum of the small bowel . T-cell lymphoma, which occurs much less frequently than B-cell lymphoma, tends to develop in the proximal portion of the small bowel, such as the jejunum or proximal ileum.”
    Tumors of the jejunum and ileum: a pattern‐based imaging approach on CT
    Kim SW et al.
    Abdominal Radiology (2019) 44:2337–2345
  • “Perforation is observed in 16–33% of patients with T-cell lymphoma at the time of clinical presentation, and this is attributed to transmural involvement and necrosis. Additionally, T-cell lymphoma is more likely to be multifocal disease than is B-cell lymphoma. In patients with celiac disease, there is an increased incidence of T-cell lymphoma in the small bowel, especially jejunum.”
    Tumors of the jejunum and ileum: a pattern‐based imaging approach on CT
    Kim SW et al.
    Abdominal Radiology (2019) 44:2337–2345
  • Small Bowel Lymphoma: Facts
    • third most common small bowel malignancy
    • the stomach is the most commonly affected portion of the gastrointestinal tract followed by the small bowel
    • distal ileum has the greatest amount of lymphoid tissue, so it the most commonly affected segment of small bowel
    • Most cases involving the small bowel are non-Hodgkin B-cell lymphoma
    • T-cell lymphoma has a high association with celiac disease and occurs most commonly in the jejunum
  • Small Bowel Lymphoma: Facts
    • risk factors for development of small bowel lymphoma include;
    • acquired immunodeficiency syndrome
    • inflammatory bowel disease
    • immunosuppression after solid organ transplantantion
    • systemic lupus erythematosus
    • Chemotherapy
    • Epstein-Barr virus has a known association with Burkitt lymphoma which commonly occurs in the ileocecal re- gion in pediatric patients
  • Small Bowel Lymphoma: Facts
    In Western countries, B-cell lymphoma of mucosa- associated lymphoid tissue (MALT lymphoma) is the most common subtype of primary small bowel lym- phoma. T-cell lymphomas are much less common and primarily occur in the setting of celiac disease
  • Lymphoma of the Small Bowel: Facts
    • Third most common small bowel malignancy. 
    • Inflammatory bowel disease and history of solid organ transplantation are known risk factors
    • Stomach is the most common site of gastrointestinal tract involvement followed by ileum
    • Infiltrating mildly enhancing mass ± regional lymphadenopathy and splenomegaly. Classic “aneurysmal bowel dilatation” appearance of affected segment. 
    • Non-Hodgkin B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) is the most common subtype
  • “Many risk factors for primary GI lymphoma have been described, including celiac disease, human immunodeficiency virus infection/acquired immunodeficiency syndrome, ulcerative colitis, Crohn's disease, and immunosuppression following solid organ transplantation. Patients with celiac disease have a 200-fold increased risk of developing intestinal lymphoma, particularly enteropathy-associated T-cell lymphoma, which has an extremely poor prognosis with a median survival time of 4 months.”

    Imaging of primary gastrointestinal lymphoma.
    Chang ST, Menias CO
    Semin Ultrasound CT MR. 2013 Dec;34(6):558-65.
  • “More than 90% of cases of MALT lymphoma are associated with Helicobacter pylori infection, possibly owing to clonal expansion of lymphoid cells in response to chronic antigen exposure. In some cases, eradication of H. pylori alone can lead to remission of low-grade MALT lymphoma. However, transformation of MALT into high-grade DLBCL is also known to occur.”

    Imaging of primary gastrointestinal lymphoma.
    Chang ST, Menias CO
    Semin Ultrasound CT MR. 2013 Dec;34(6):558-65. 
  • “Clinical symptoms of primary GI lymphoma on presentation are extremely nonspecific and most commonly include abdominal pain, nausea, vomiting, anorexia, or weight loss. Upper or lower GI bleeding is less common presentations.Up to half of patients can present with palpable abdominal masses, suggesting that these masses can remain asymptomatic for long time. Rarely, primary GI lymphomas can cause intussusception, obstruction, or bowel perforation.”

    Imaging of primary gastrointestinal lymphoma.
    Chang ST, Menias CO
    Semin Ultrasound CT MR. 2013 Dec;34(6):558-65. 
  • “Numerous studies have demonstrated that the stomach is the most common site of primary GI lymphoma, comprising approximately 47%-54% of all cases. Some have observed differing presentations between high- and low-grade gastric lymphomas on presentation and endoscopy, with high-grade gastric lymphomas presenting more often with vomiting and weight loss, ulcerations on endoscopy, and higher stages at presentation.Low-grade lymphomas are generally associated with H. pylori infection and demonstrate “normal” mucosa, petechial fundal hemorrhage or confinement to the antrum.”

    Imaging of primary gastrointestinal lymphoma.
    Chang ST, Menias CO
    Semin Ultrasound CT MR. 2013 Dec;34(6):558-65. 
  • “The small bowel represents the second most common site of primary GI lymphoma, comprising approximately 24%-26%. Compared with primary GI lymphoma of the stomach, which tends to be of lower grade, small-bowel lymphomas are diagnosed at higher grades.”

    Imaging of primary gastrointestinal lymphoma.
    Chang ST, Menias CO
    Semin Ultrasound CT MR. 2013 Dec;34(6):558-65.
  • “Although the ileum is most often affected by B-cell lymphomas presumably based on the relative abundance of lymphatic tissue, the jejunum appears to be more often involved in uncommon but more aggressive T-cell lymphomas. Lymphoma often affects multiple sites of small bowel with a roughly equal likelihood of affecting the same segment or different segments.Over 77% of lymphoma exceeds 5 cm in diameter, and the average length of affected bowel is 12 cm.”

    Imaging of primary gastrointestinal lymphoma.
    Chang ST, Menias CO
    Semin Ultrasound CT MR. 2013 Dec;34(6):558-65. 
  • “Lymphoma of the small bowel commonly demonstrates an infiltrative pattern causing diffuse bowel wall thickening with or without aneurysmal dilation and less often an “annular napkin-ring lesion” mimicking adenocarcinoma. Other patterns of small-bowel lymphoma include solitary or multiple nodules or large polypoid masses.The differential diagnosis for these findings includes Crohn's disease, adenocarcinoma, carcinoid, GI stromal tumor, or metastatic disease (eg, melanoma).”

    Imaging of primary gastrointestinal lymphoma.
    Chang ST, Menias CO
    Semin Ultrasound CT MR. 2013 Dec;34(6):558-65. 
  • “The survival rate for primary GI lymphoma is highly variable depending on stage, primary site, and subtype, but is generally good, ranging from 44%-67%.Distinguishing between primary and secondary GI lymphoma is clinically important, however, because primary GI lymphoma carries a better 5-year survival rate than disseminated secondary GI lymphoma and a significantly better survival rate than other common GI malignancies such as adenocarcinoma. Tumors are often amenable to chemotherapy and radiation, and can occasionally undergo surgical debulking or resection due to perforation or other acute complication.”

    Imaging of primary gastrointestinal lymphoma.
    Chang ST, Menias CO
    Semin Ultrasound CT MR. 2013 Dec;34(6):558-65. 
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