(Eds.). Your healthcare provider will determine the best course of treatment depending on your individual circumstances. Abdominal Manifestations of Lymphoma: Spectrum of Imaging Features, Hospital das Clínicas da Universidade Federal de Pernambuco, UFPE, Escola Paulista de Medicina, UNIFESP, Avenida Professor Moraes Rego, s/n, Cidade Universitária, 50670-420 Recife, PE, Brazil, T. C. Kwee, R. M. Kwee, and R. A. J. Nievelstein, “Imaging in staging of malignant lymphoma: a systematic review,”, W.-K. Lee, E. W. F. Lau, V. A. Duddalwar, A. J. Stanley, and Y. Y. Ho, “Abdominal manifestations of extranodal lymphoma: spectrum of imaging findings,”, R.-S. Yu, W.-M. Zhang, and Y.-Q. Extranodal lymphoma in the GI tract occurs in 10–30% of all patients with NHL . Focal masses of ARL may be seen in the stomach, small bowel, or colon. Some patients with lymphoma undergo PET scanning after receiving therapy to determine if the cancer is responding to treatment. Currently, it is not possible to prevent Lymphoma of Stomach. the overall health condition of the individual, which could range from being fully active (low risk) to being completely disabled (very high risk), Individual, who have already suffered from lymphoma, or other types of blood cancers, may have a relapse or a recurrence, Presence of an immunodeficiency syndrome, like AIDS, is a high risk factor, Those infected with Epstein-Barr virus are also prone to this lymphoma type, Change of regulatory elements of certain cancer-causing genes called as oncogenes, which can lead to increased production of their mRNA (overexpression), thus increasing their protein levels, Exchange of protein coding regions of gene, giving rise to new proteins that can stimulate the inappropriate growth of cells, Unintentional weight loss; changes in appetite, High temperatures and excessive night sweats (may be recurrent), A thorough physical examination and a complete medical history, which is very important, Complete blood cell count (CBC) blood test, Absolute lymphocyte count on peripheral blood, A biopsy of the tumor is performed and sent to a laboratory for a pathological examination. The patterns of bladder involvement include circumscribed solitary or multiple masses and diffuse infiltration . Certain subtypes of lymphoma, such as extranodal marginal zone lymphoma and T-cell cutaneous lymphoma , exhibit variable FDG uptake (Fig. The signs and symptoms of Lymphoma of Stomach may include: In case the condition spreads from the stomach with the involvement of other organs, then the signs and symptoms may be based on specific organs that are affected. Adler, N. E., & Page, A. E. Appendiceal lymphoma may present clinically as acute appendicitis . The radiographic, CT, and barium examination features of intrinsic bowel involvement are similar in patients with AIDS and immunocompetent patients, and no gross morphologic differences among the different histologic types are found [17, 18]. HD of the colon is uncommon [5, 10]. Extranodal involvement (except in the spleen and thymus) indicates stage IV HD. CT scan imaging with IV contrast of chest, abdomen, and pelvis can be done to measure the tumor load. Pancreatic HD is extremely rare and, in almost all cases, secondary to contiguous lymph node disease [5, 12]. The healthcare provider may help assess the risk-benefit analysis, depending upon each individual’s specific circumstances. The test uses a radioactive glucose (sugar) molecule, called FDG, to produce i… However, lymphoma could be in neck, chest, etc and be undetected. Elevated level of serum lactate dehydrogenase - LDH (a type of enzyme), Performance status, i.e. They … This image reveals diffuse renal lymphoma, in which diffuse, small nodules are scattered throughout both kidneys. Primary lymphoma of the appendix is also very rare, with only a few case reports in the literature, although it is more common to see cecal lymphoma extending to the base of the appendix [10, 11]. CT scans are used to look at the head and neck, spine, chest, abdomen (stomach) and pelvis. The patterns of gastric involvement include polypoidal mass, diffuse or focal infiltration, ulcerative lesion, or mucosal nodularity . General information on lymphoma and lymphocytes: No specific risk factors have been identified for Lymphoma of Stomach. If lymphoma or another serious condition is suspected, your doctor may order imaging tests like X-rays or a CT scan. We are committed to sharing findings related to COVID-19 as quickly as possible. There are other tests and procedures that could help in the diagnosis and these include: Note: Differential diagnoses, to eliminate other tumor types are often considered, before arriving at a definitive diagnosis. Diffuse infiltration may be present in spleens of normal size. If nodes have low-attenuation centers, mycobacterial infection, rather than lymphoma, is likely . Lymphoma of the Stomach. Primary NHL, Burkitt lymphoma, MALT-type lymphoma, and, rarely, HD have been described involving the small intestine . Tolerance to the chemotherapy sessions is a positive influencing factor, Progression to bone marrow failure is usually associated with short survival, Treatment for Lymphoma of Stomach can cause physical and emotional distress; supportive care and encouragement, help positively and can bring a measure of relief to the patients. They fight bacterial cells, cell fragments, and other immunogenic elements, Natural killer cells or NK cells: They perform diverse functions related to both cell-mediated and humoral immunity. Peritoneal lymphomatosis is a rare clinical presentation that is often associated with high-grade primary gastrointestinal NHL and is radiologically indistinguishable from peritoneal carcinomatosis [2, 15]. Lymphoma of the stomach. Two hundred fifty-seven patients achieved complete response; 78 who relapsed form the basis of this study. Contiguous disease, which requires local radiation therapy, must be distinguished from stage IV disease, which is treated with chemotherapy alone or combined with general radiation therapy. A grossly enlarged psoas muscle may represent a primary manifestation of ARL . In a majority of primary lymphomas, if the tumor is small, it may be usually asymptomatic and the individuals will not have any significant symptoms. Renal involvement is extremely rare, with HD being rather perirenal and with radiologic appearance often consisting of invasion of the perirenal space by HD without renal parenchymal involvement . Also the extent of extranodal involvement must be evaluated because it is considered prognostic . A CT scan of this area may be done to look for abscesses, tumors, kidney stones, infections, or the cause of unexplained abdominal pain. Testicular lymphoma is a rare and deadly disease representing 1% to 2% of all NH and approximately 5% of all testicular neoplasms. Masses may be sharply circumscribed or may infiltrate into the renal sinus or surrounding tissues [16, 17]. Focal masses of ARL in the kidney are not as common as in the liver or spleen. Please remove adblock to help us create the best medical content found on the Internet. CT scans of internal organs, bone, soft tissue and blood vessels provide greater clarity than conventional x-ray exams. Despite peripelvic lymphoma encasing renal hilar structures, the vessels often remain patent, and there is often minimal hydronephrosis (Figure 30) which helps to differentiate peripelvic lymphoma from transitional cell carcinoma or metastases . Note: Men and women in child-bearing age would greatly benefit from counseling regarding fertility issues. FDG positron emission tomography (PET) imaging has been shown to be an important technique for both staging and follow-up of nodal and extranodal lymphomas . Lymphocytes are a type of white blood cells that are responsible for providing immunity in the human body. For initial staging of splenic involvement in malignant lymphoma, the sensitivity and specificity of PET/CT can reach 100% and 95%. Intrinsic involvement of genitourinary (GU) organ systems at presentation is rare . Baarslag et al., “CT and18F-FDG PET for noninvasive detection of splenic involvement in patients with malignant lymphoma,”, N. P. Leite, N. Kased, R. F. Hanna et al., “Cross-sectional imaging of extranodal involvement in abdominopelvic lymphoproliferative malignancies,”, A. Psyrri, S. Papageorgiou, and T. Economopoulos, “Primary extranodal lymphomas of stomach: clinical presentation, diagnostic pitfalls and management,”, S. Ghai, J. Pattison, S. Ghai, M. E. O'Malley, K. Khalili, and M. Stephens, “Primary gastrointestinal lymphoma: spectrum of imaging findings with pathologic correlation,”, D. S. Katz, L. B. Stein, and J. P. Mazzie, “Recurrent non-Hodgkin's lymphoma of the appendix,”, E. M. Merkle, G. N. Bender, and H.-J. Nodal disease can be solitary or more commonly multiple . This tool can help in diagnosing relapse and restart treatment as needed, Fluorescence in situ hybridization (FISH): It is a test performed on the blood or bone marrow cells to detect chromosome changes (cytogenetic analysis) in blood cancer cells. In women, in many cases, due to urgency of starting chemotherapy, it is often difficult to perform ovum banking. Splenic involvement is found at initial presentation of lymphoma in 30–40% of patients with HD and in 10–40% of patients with NHL . On CT images, lymphoma of the abdominal solid organs often manifests as multiple solid masses frequently demonstrating enhancement . Enlarged LN can be fused together and form a huge mass and can be seen on CT as uniform density lesions with mild homogenous enhancement . Focal hepatic lymphoma appears as circumscribed nodules that are hypoechoic and show no posterior acoustic enhancement on US. CT is preferred for evaluating hepatic lymphoma and diagnosing gastric lymphoma and renal or perirenal masses . In decreasing order of frequency, the spleen, liver, gastrointestinal tract, pancreas, abdominal wall, genitourinary tract, adrenal, peritoneal cavity, and biliary tract are involved. The patterns of renal involvement, in descending order of frequency, include multiple circumscribed masses (Figure 27), direct infiltration from adjacent nodes, a solitary mass, an isolated perinephric mass (Figure 28), and diffuse infiltration (Figure 29) [2, 13]. The symptoms also depend upon the extent of lymphoma involvement in other parts of the body. Many clinical conditions may have similar signs and symptoms. The International Prognostic Index, for aggressive non-Hodgkin lymphoma, lists a few factors that determine the overall risk: It is important to note that having a risk factor does not mean that one will get the condition. HD manifests more often as miliary lesions (<1 cm in diameter) than as masses (Figure 16) [5, 8]. Our surgeons have expertise in performing lymph node biopsies that ensure adequate tissue is gathered to make a precise diagnosis. (2004). In addition, ARL have a striking predilection for extranodal areas of involvement, and the GI tract is the most common extranodal site . The stomach, small bowel, pharynx, large bowel, and esophagus are involved in decreasing order of frequency . Recurring tumors have worse prognosis compared to tumors that do not recur, Response to treatment: Tumors that respond to treatment have better prognosis compared to tumors that do not respond to treatment, Progression of the condition makes the outcome worse (progressive Gastric Lymphoma), The combination chemotherapy drugs used, may have some severe side effects (such as cardio-toxicity). Maybe: If advanced lymphoma were present in the area of ct scan (abdomen), then yes. Johns Hopkins University Press. 2013, Article ID 483069, 11 pages, 2013. https://doi.org/10.5402/2013/483069, 1Hospital das Clínicas da Universidade Federal de Pernambuco, UFPE, Escola Paulista de Medicina, UNIFESP, Avenida Professor Moraes Rego, s/n, Cidade Universitária, 50670-420 Recife, PE, Brazil. The confluence of enlarged LN of HD is seldom seen (16.7%), which mainly occurs in multiple-nodular type (60%). Abdominal scans can be used to help a doctor pinpoint the location of a tumor before a biopsy is performed. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Materials and methods: A total of 328 patients with previously untreated stage I, II, or III follicular lymphoma were treated between 1978 and 1994. This chiefly impacts the elderly adults, or those who are already affected by other medical conditions. Copyright © 2013 Adonis Manzella et al. Ansari, M., Nasrolahi, H., Kani, A. CT usually shows a huge round mass or a lobular homogeneous density mass with uniform enhancement . Extranodal lymphoma has been described in virtually every organ and tissue. In general, the prognosis depends upon a set of several factors, which include: Stage of tumor: With lower-stage tumors, when the tumor is confined to site of origin, the prognosis is usually excellent with appropriate therapy. Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. On contrast-enhanced CT, the nodules are low attenuation (Figures 17 and 18), and on MRI, they may appear as hypointense or isointense compared with normal liver on T1-WI and as hyperintense on T2-WI (Figure 19) and may show reduced enhancement [2, 8]. The appearance may vary from one or a few large low-attenuation masses to multiple small nodules. Liu, “CT diagnosis of 52 patients with lymphoma in abdominal lymph nodes,”, U. Metser, O. Goor, H. Lerman, E. Naparstek, and E. Even-Sapir, “PET-CT of extranodal lymphoma,”, A. Guermazi, P. Brice, E. De Kerviler et al., “Extranodal Hodgkin disease: spectrum of disease,”, R. E. Dorfman, M. B. Alpern, B. H. Gross, and M. A. Sandler, “Upper abdominal lymph nodes: criteria for normal size determined with CT,”, P. A. Nevertheless, this procedure is not very much used, Bone marrow aspiration and biopsy is performed and sent to a laboratory for a pathological examination, to determine if the bone marrow is involved. However mild-to-moderate reactive splenomegaly (Figure 8) occurs in about 30% of patients in the absence of lymphoma deposits [5, 8]. Lymphoma of the gastrointestinal tract is a rare disease with an incidence of 1.6 per 100,000. Removing a lymph node for testing. Diffuse organ involvement is also possible, most commonly affecting the liver and spleen with corresponding organomegaly and variable CT attenuation . In addition, depending on the complications and symptoms you experience, doctors may recommend you for chest X-ray, PET, body CT scan, lumbar puncture, bone scan, abdominal ultrasound or body MRI to determine the spread of lymphoma. It is most commonly used in combination with chemotherapy, The radiation may be administered by a machine placed outside the body, or by placing a radioactive material inside the body, The side effects of radiation therapy include nausea, vomiting, fatigue, pain, risk of cancer later in life, and risk of heart disease, Radiation can damage healthy cells in addition to cancer cells, causing further complications, Supportive treatment: Steroids, blood transfusions, anti-nausea medications, and antibiotics, may be used as supportive therapy. Friedman, M., Lee, K. R., Kim, H. J., Lee, I. S., & Kozukue, N. (2005). In higher-stage tumors, such as tumors with metastasis, the prognosis is poor, Overall health of the individual: Individuals with overall excellent health have better prognosis compared with those with poor health, Age of the individual: Older individuals generally have poorer prognosis than younger individuals, The size of the tumor: Individuals with small-sized tumors fare better than those with large-sized tumors, Individuals with bulky disease have a poorer prognosis, Involvement of vital organs may complicate the condition, The surgical respectability of the tumor (meaning, if the tumor can be removed completely) - it is a rare option, Whether the tumor is occurring for the first time, or is a recurrent tumor. This could be from lymph nodes or organs such as the spleen or liver enlarging, but it can also be caused by the build-up of large amounts of fluid. Springer-Verlag. Extranodal involvement is much less common in HD than in NHL. A computed tomography (CT) scan showing bulk disease in a patient with Hodgkin lymphoma. Extranodal lymphoma occurs in about 40% of patients and has been described in virtually every organ and tissue. However, the condition is known to be associated with the following factors: Besides the above, the following general factors may contribute towards lymphoma formation and development: International Prognostic Index: According to some scientists, the International Prognostic Index may not be very helpful in evaluating Lymphoma of Stomach. MRI is used in local staging of rectal cancers. However, secondary liver involvement is fairly common and is usually associated with lymph node disease. on a CT scan. BMC cancer, 13(1), 1. Non-Hodgkin and Hodgkin lymphomas frequently involve many structures in the abdomen and pelvis. Hence, measures to protect the individual’s fertility must be considered, before starting chemotherapy, Chemotherapy: This approach uses a combination of drugs to kill the cancerous cells and can be used in patients, for all stages of the tumor, There can be severe side effects including fatigue, nausea, hair loss, anemia, high risk of infection, and drug-specific reactions, Many lymphomas can be resistant to chemotherapy. Blood test results help determine how the liver and kidneys are functioning. Profession involving radiation exposure, which may include nuclear plant workers, pilots, astronauts, etc. Due to this, individuals are more vulnerable to infections; there is an increased risk of developing serious complications from such infections, Occasionally, the tumor can transform into a more aggressive form or subtype of lymphoma, Side effects such as dizziness, vomiting, appetite loss, mouth ulcers, and hair loss, By damaging healthy cells, the individual is more open or vulnerable to secondary infections, The treatment can also cause infertility in men and women. There are 2 types of lymphoma: The cause of Lymphoma of Stomach is unknown. CT of the abdomen demonstrates lymph nodes involving mesenteric vessels (sandwich sign) anterior to aorta and inferior to vena cava in a patient with lymphoma (arrows). Purpose: To evaluate the efficiency of axial computed tomography (CT) in detecting relapses of stage I, II, or III follicular lymphoma. NHL has a wide distribution including all sites of abdominal LN (Figure 6), and the mesentery is frequently involved (45%). Lymphoma is the most common malignancy of the small bowel, and in recent years its incidence related to B-cell hyperactivation in HIV-positive patients has increased. There are 3 different kinds of lymphocytes: T-lymphocytes or T cells: They help combat infections and abnormalities within the cells (cell-mediated immunity). Lymphomatous involvement of the biliary tree is rare. Also, not having a risk factor does not mean that an individual will not get the condition. Marked splenomegaly almost always indicates infiltration. As other answers have stated, what CT (and MRI, and ultrasound) can show is the overall size of the lymph nodes, and in some cases how much blood supply they have. Ultrasound scan of the stomach/abdomen; Computerized tomography (CT) scan of the stomach/abdomen; Vascular radiological studies; Whole body bone scan; Whole body CT-PET scans to determine how far the lymphoma has spread, by checking the size and metabolic rate (a reflection of uncontrolled growth) of lymph nodes, throughout the body. This can also help determine, if the cancer has spread to other organ systems, Brain MRIs are used if neurological symptoms are present, which can help determine if the cancer has spread to the brain, or to tissues that cover the brain, Exploratory laparoscopy (diagnostic laparoscopy) may be required, if gastrointestinal symptoms are present. At MR nodules are hypointense or isointense on T1-weighted images (T1-WI) and hyperintense on T2-WI and demonstrate reduced enhancement after administration of gadolinium (Gd) compared with normal spleen . The American surgeon, 55(11), 665-668. Focal hepatic masses of lymphoma are much more common in AIDS patients than in the non-AIDS population. Lymphocytes are made in bone marrow, and can develop into either B-cells or T-cells, Lymph results from filtration of blood as it travels to and from tissues. Lymph is colorless because it lacks red blood cells; instead, it contains lymphocytes. The images can then be examined on a computer monitor or printed. Computed tomography (CT) scan in a 52-year-old woman with non-Hodgkin lymphoma. Some risk factors are more important than others. The signs and symptoms depend on whether it is a primary condition or a secondary condition. In such cases, initial baseline PET/CT is particularly important for facilitating assessment of therapeutic response. The patterns of involvement include discrete nodules, a diffuse infiltrative mass, and ascites (Figure 32). Masses in the GI tract may be isolated findings, but evidence of disease elsewhere is common. In 1987, the Centers for Disease Control and Prevention (CDC) included several histologic types of high-grade and intermediate-grade NHL in a list of diseases that indicate a diagnosis of AIDS in patients with laboratory evidence of HIV infection . This computed tomography scan is from a 46-year patient with Hodgkin lymphoma at the level of the neck. Renal involvement occurs in 3–8% of patients with lymphoma. The test helps in identifying genetic abnormalities that may not be evident with an examination of cells under a microscope, Immunophenotyping to identify a specific type of cell in a sample, which can help determine the best treatment course to be followed, Polymerase chain reaction (PCR): It is used to measure the presence of certain biomarkers in blood or bone marrow cells. In Gastrointestinal and Liver Tumors (pp. The infiltrating form is the most common (Figure 20) and may be difficult to differentiate from scirrhous carcinoma. It can also damage healthy cells, Chemotherapy can be administered as a pill, liquid, shot, or intravenously, Surgical removal of the lymphoma from the stomach, Radiation: Radiation therapy is the use of high-energy radiation waves to kill cancer cells, by destroying their DNA, This treatment modality is generally used for early stage lymphomas. Fluorodeoxyglucose with positron emission tomography (FDG-PET) is an effective tool for detecting lymphoma and other cancers. A. Esplin, A. M. Levine, and P. W. Ralls, “AIDS-related non-Hodgkin's lymphoma: abdominal CT findings in 112 patients,”, R. R. Townsend, “CT of AIDS-related lymphoma,”, E. J. Balthazar, M. Noordhoorn, A. J. Megibow, and R. B. Gordon, “CT of small-bowel lymphoma in immunocompetent patients and patients with AIDS: comparison of findings,”. Regular medical screening at periodic intervals with blood tests, scans, and physical examinations, are mandatory. They also scout for cancer cells, a process called immune surveillance, Lymphoma of Stomach is an infrequent condition that generally affects older adults, It can occur worldwide and all races and ethnic groups may be affected, Advanced age; older individuals commonly have a higher risk, Individuals with weak immune system (due to various health conditions), Exposure to radiation and industrial chemicals, Viruses (in some rare cases); Epstein-Barr virus infection. In combination with other treatment measures, these can help combat the symptoms of immunodeficiency, Undertaking treatment of underlying conditions/disorders, as warranted, If Gastric Lymphoma is not fully responsive to treatment, or if the chance of recurrence is high, then bone marrow transplantation or stem cell transplantation can be considered, In order to prevent infections because the immune system is weakened by the lymphoma or by its treatment, the patient is kept in an isolated ward and treated with appropriate antibiotics, Nowadays targeted therapies are being developed that can selectively kill the cancer cells. A biopsy of involved tissue or lymph nodes is essential in order to make a diagnosis. Unlike other subtypes, the gastric MALT lymphoma is associated with gastritis (bacterial infection causing stomach inflammation), Lymphoma of Stomach may be associated with autoimmune disorders. Nodules are characteristically hypoechoic at US (Figure 9), but very small deposits may not be detected. Bailey, R. L., & Laws, H. L. (1989). Although bile duct obstruction may occur, moderate-to-severe dilatation of the main pancreatic duct is uncommon . However, some scientists believe that it is helpful in some cases, to determine the prognosis. 7A, 7B) and can be difficult to detect with conventional contrast-enhanced CT.
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