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Year : 2004  |  Volume : 14  |  Issue : 4  |  Page : 415-417
Primary nonhodgkins lymphoma of ileum


Dept. of Radiodiagnosis, Gem Hospitals Pvt. Ltd, Pankaja Mills Road, Coimbatore, Tamil Nadu, Pin-641045, India

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How to cite this article:
Chegu D, Karthikeyan D. Primary nonhodgkins lymphoma of ileum. Indian J Radiol Imaging 2004;14:415-7

How to cite this URL:
Chegu D, Karthikeyan D. Primary nonhodgkins lymphoma of ileum. Indian J Radiol Imaging [serial online] 2004 [cited 2019 Sep 19];14:415-7. Available from: http://www.ijri.org/text.asp?2004/14/4/415/28685
Primary lymphomatous tumours constitute about.9 % of all gastro intestinal tract tumours, Mostof Gastro intestinal lymphomas are NonHodgkinsLymphomas and are commonly derived from B-cells fromthe lymphoid tissue present in the lamina propria andsubmucosa .

Small bowel lymphoma most commonly involves theterminal ileum and can present as circumferential mass,narrowed lumen or aneurysmal dilatation, and cavitarylesions. here we present a case of distal ileal Nonhodgkins lymphoma with a brief review of literature .


   Case report Top


68 yr old lady presented with history of progressivelyincreasing swelling of abdomen with pain and loss ofweight of about 4 month duration. She underwent a plainradiograph of abdomen ,usg , colonoscopy and ct scanfollowed by surgery .

Plain abdominal radiograph in ap projection reveals asoft tissue density in the right iliac and umbilical region.[Figure - 1]

Bmode Ultrasound done ( aloka ssd 5000) revealed alarge heterogenous mass lesion with cystic necroticcomponents in the right iliac ,lumbar and umbilical regionengulfing a dilated fluid filled bowel loop. [Figure - 2]

contrast enhanced spiral Ct scan (GE spiral ct using 80ml of intravenous contrast medium) showed a largesausage shaped lesion having homogenously thickenedwalls with a exophytic component showing necrosis inthe region of distal ileum, luminal component showsopacification with oral contrast suggesting a infiltrativeform of lymphoma . [Figure - 3][Figure - 4] ,screening ct of lungs wasnormal .

Colonoscopy was normal except for a extrinsic impressionin the ileocecal junction area. At surgery a large firm 14x12cm mass arising from the ileum 5 feet from the duodenaljejunal flexure. Multiple mesenteric nodes noted. Lowerpart of the mass was adherent to the serosa of the urinarybladder. Excision followed by end to end anastomaosisof ileum to transverse colon was performed

Histopathology revealed a a nonHodgkins lymphoma,diffuse largecell type of intermediate grade. Mesentriclymphnodes showed the same morphology


   Discussion Top


Lymphoma of the small intestine make upto one half ofthe primary malignant tumour of the small intestine . smallbowel ( distal ileum )is the second most common sitenext to stomach for gastrointestinal lymphomas, fordiagnosis of primary gastrointestinal lymphomas thefollowing criteria should be met 1) no palpable superficialnodes , 2) normal cxr 3) normal white cell count 4) atsurgery a predominant alimentary tract lesion with nodesconfined to the drainage area 5)no involvement of liverand spleen.

Most of the patients present with pain and obstructivesymptoms , palpable mass is present in more than athird of patients .patients may also present with historyof malabsoprtion for several years prior.

Small bowel lymphoma orginates in the lymphoid follicleof the submucosa and may be solitary or diffuse , solitaryform tends to encircle the bowel and narrow the lumen .Diffuse form shows multisegment involvement withnumerous polypoidal excersences. Enlarged nodes inthe mesentery adjacent to the lesion are common inprimary lymphoma of the small bowel .

Radiologic appearances include six patterns

  1. aneurysmal form - caused by replacement of muscularis and destruction of the autonomic nerve plexus causing a focal bulge on the antimesentric border.
  2. infiltrative - involves a variable length with thickening and later effacement of folds ,the lumen is often widened with thickening of the walls .
  3. nodular - two patterns - a diffuse nodular pattern seen commonly in the mediteranien type of lymphoma , a polypoidal type ,this form is usually associated with intussusception .
  4. ulcerative - this form presents as multiple ulcerated areas with normal intervening mucosa ,may have associated excavations with risk of localized perforation in to sealed off space usually between leaves of mesentry .
  5. mesenteric form - mass arising from the mesenteric node ,eventually involving the adjacent small bowels causing a sandwitch pattern .
  6. sprue form .- may present with nodular fold thickening associated with coeliac disease .



   Conclusion Top


Radiologically gastrointestinal lymphomas have similarmorphologic features regardless of the site of orgin .Ctscan is very useful in staging as it demonstrates theextraluminal component of the mass and also thepresence of paraaortic and retroperitoneallymphadenopathy. Computed tomography also suppliesinformation regarding the status of the liver and spleen.[6]

 
   References Top

1.Dodd GD, imaging of lymphomas ,RCNA,vol28/no4 july 1990.  Back to cited text no. 1    
2.Zoronzaj, Dodd GD , lymphomas of the gastro intestinal tract,seminars in roengenology15:272 1980.  Back to cited text no. 2    
3.John R. Haaga , charles f.lanzeri computed tomography and magnetic resonance imaging of the whole body , 3rd edition .  Back to cited text no. 3    
4.Dean T.Maglinte , chapter 51 ,text book of gastrointestinal radiology by Richardm.Gore , Marc,S.Levine .  Back to cited text no. 4    
5.Fecsko PJ, malignancy complicating inflammatory bowel disease ,radiology clinics of North America , 25 157- 174, 1987 .  Back to cited text no. 5    
6.Weinberg DS pathology of lymphomas ,1985, seminars in ultrasound CT and MRI.  Back to cited text no. 6    

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Correspondence Address:
D Chegu
Dept. of Radiodiagnosis, Gem Hospitals Pvt. Ltd, Pankaja Mills Road, Coimbatore, Tamil Nadu, Pin-641045
India
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Source of Support: None, Conflict of Interest: None


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    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]

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