GIT LYMPHOMAS

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.

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

G I lymphomamay either represent secondary involvement by systemic disease or primary malignancy confined to theGI tract GIT-lymphoid Elements Seen In The Lamina Propria and Sub MucosaSecondary GI Involvement Is CommonPrimary 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.

OesophagusEsophagus: 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 represents the most common site ofextra nodal lymphoma, accounting for 25% of all such lymphomas, 50% of all gastrointestinal lymphomas, but comprise only 1-5% of allgastric 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 underlyinglymphoma.Gastric lymphoma

PathologyThree distinct types of gastric lymphoma are recognized:

low-grade MALT lymphoma : 60% of all primary gastric lymphomasprimary sporadic lymphoma : vast majority are B-cellnon-Hodgkins lymphomasecondary involvement of the stomach by systemic lymphoma (usually high grade)

Mucosa-associated lymphoid tissue (MALT) lymphomaand are strongly associated with Helicobacter pylori(85 - 98% of cases). These are low-grade lymphomas and may regress following treatment ofHelicobacterinfection.

Radiographic features Gastric lymphoma Fluoroscopy : Barium meal

Appearances vary from normal, to grossly abnormal. Possible appearances include:

bull's eye appearancedue 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 ingastric 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 LymphomasLocation 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 mesentryOmental caking Nodular or strand like soft tissue densityCalcified fociRounded mass

Peritoneal And Omental Mass

Small Intestine .. Fold Thickening Luminal Narrowing

Thickened Mucosal Folds With Ulceration

THANK YOU

**