Unknown Case of the Month #3 |
| Findings: |
| The film from the small bowel series shows an abnormal distal loop of jejunum exhibiting a loss of the normal feathery mucosal pattern with aneurysmal dilatation of its central portion. A slice from the abdominal CT at the level of the abnormal distal loop of jejunum again shows aneurysmal dilatation with marked associated thickening of the bowel wall, measuring up to 2.5 cm in cross sectional diameter. These findings are characteristic of small bowel lymphoma. |
| Diagnosis: Burkitt's Lymphoma of the Small Bowel |
| Lymphoma of the bowel accounts for 5% of all bowel tumors and is the most common extranodal site for lymphoma to develop. The most common sites in descending frequency are stomach, small bowel, and colon. 50-60% of cases are non-Hodgkin's lymphoma and 50% of all cases of non-Hodgkin's lymphoma involve the bowel. Frequent associated conditions include: atrophic gastritis, immunodeficiency states, immunosuppressive drugs, parasitic infections, and celiac disease. |
| The symptoms are nonspecific (pain, weight loss, nausea, vomiting, GI bleeding and anemia) and may be present for years before the diagnosis is established. Histologically, the tumor is characterized by a uniform dense lymphocytic infiltration of the submucosa; hence endoscopic biopsy of the superficial mucosa may initially be negative. Primary management is based upon surgical debulking (50% 5-year survival for "curative" resection), while the role of postoperative radiation and chemotherapy remain unclear. |
| Lymphoma of the bowel produces a spectrum of radiologic findings, including: thickened folds and increased bowel wall thickness, multiple small nodules large polypoid masses, ulceration, and abscess formation. Intussusception and frank perforation may occur. Luminal narrowing is unusual. Extensive excavation and denervation may result in aneurysmal dilatation as seen in the present case. Detection of associated lymphadenopathy is an important indicator of survival. |
| References: |
| Buckley JA, Fishman EK. CT evaluation of small bowel neoplasms: spectrum of disease. Radiographics 1998;18:379-392. |
| Rubesin SE, Gilchrist AM, Bronner M, Saul SH, Herlinger H, Grumbacj K, Levine MS, Laufer I. Non-Hodgkin lymphoma of the small intestine. Radiographics 1990;10:985-998. |
| Smith C, Kubicka RA, Thomas CR Jr. Non-Hodgkin lymphoma of the gastrointestinal tract. Radiographics 1992;12:887-899. |
| Dr. Lawrence C. Swayne, Attending Dr. Sean Calhoun, Chief Resident Diagnostic Radiology Morristown Memorial Hospital |
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