Intestinal Lymphoma

Case Presentation
A 81 year old male presented with asthenia and loss of weight.

1- Transverse scan in the right lower quadrant 2 -Sagittal scan in the right lower quadrant
Caption: 1- Transverse scan in the right lower quadrant 2 -Sagittal scan in the right lower quadrant | Description: Thickening of small bowel wall. “Pseudo-kidney” sign.

First published on SonoWorld

CT Axial – Coronal –Sagittal
Caption: CT: Axial – Coronal –Sagittal | Description: Circunferencial small bowell wall thickening with mild decrease of the lumen, involving a relatively long segment , without obstruction.

Differential Diagnosis



Crohn's Disease

Infectious Ileitis



Final Diagnosis

Intestinal Lymphoma  (Non-Hodgkin lymphoma of the small bowel).



"The ileum and the cecum are the most common sites of involvement by primary lymphoma in the small and large bowel, respectively. The lymphoma may also extend to the appendix.

Lymphoma of the ileocecal region most commonly manifests as single or multiple segmentalareas of circumferential thickening with homogeneous attenuation and poor enhancement. The bowel wall may display symmetric thickening and is usually markedly thickened (1.5–7 cm).

Lymphoma of the ileocecal area may also be seen as a polypoid lesion of variable size that may act as the lead point of an intussusception. Lymphoma may mimic adenocarcinoma, but in the former, the segment of bowel involved is usually longer; the transition from tumor to normal bowel is much more gradual; and associated, possibly bulky mesenteric and retroperitoneal lymph nodes are usually seen encroaching on the vessels from both sides .

A classic complication is ulceration with formation of a fistulous tract to adjacent bowel loops. An excavating mass is one that involves the entire bowel wall, with bowel entering and exiting the mass. The lumen or cavity of the mass fills with contrast material and is usually larger than the bowel entering it; this condition is referred to as aneurysmal dilatation of the bowel".

The above discussion is quoted from article:
Multi–Detector Row CT: Spectrum of Diseases Involving the Ileocecal Area
Christine Hoeffel, MD, Michel D. Crema, MD, Ahcène Belkacem, MD, Louisa Azizi, MD, Maité Lewin, MD, PhD, Lionel Arrivé, MD and Jean-Michel Tubiana, MD
doi: 10.1148/rg.265045191 September 2006 RadioGraphics, 26, 1373-1390.

Follow Up

Histological appearance, immunohistochemistry and flow cytometry indicate malt lymphoma of the jejunum. (B lymphoma), with lymphomatous spread of the lymph nodes (6/6).

1. Multi–Detector Row CT: Spectrum of Diseases Involving the Ileocecal Area.
Christine Hoeffel, Michel D. Crema, Ahce`ne Belkacem,Louisa Azizi, Maite´ Lewin, Lionel Arrive´, Jean-Michel Tubiana. September 2006 RadioGraphics, 26, 1373-1390.

2. Bowel Wall Thickening on Transabdominal Sonography
Hans Peter Ledermann, Norbert Börner, Holger Strunk, Georg Bongartz, Christoph Zollikofer and Gerd Stuckmann
American Journal of Roentgenology 2000 174:1, 107-115