Non-Hodgkin lymphoma (also known as non-Hodgkin’s lymphoma, NHL, or lymphoma) is a cancer that starts in the lymphocytes, which are. Find out what you need to know about malignant lymphoma, including symptoms, treatment, and outlook. ON THIS PAGE: You will learn about how doctors describe lymphoma’s location and spread. This is called the stage. Use the menu to see other g.
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This is an open lmifoma article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Non-Hodgkin and Adaalah lymphomas frequently involve many structures in the abdomen and pelvis. Though it may be part of a systemic lymphoma, single onset of nodal lymphoma is not rare.
Extranodal lymphoma has mwligna described in virtually every organ and tissue. In decreasing order of frequency, the spleen, liver, gastrointestinal tract, pancreas, abdominal wall, genitourinary tract, adrenal, peritoneal cavity, and biliary tract are involved. The purpose of this review is to discuss and illustrate the spectrum of appearances of nodal and extranodal lymphomas, including AIDS-related lymphomas, in the abdominopelvic region using a multimodality approach, especially cross-sectional imaging techniques.
What Is Hodgkin Lymphoma?
The most common radiologic patterns of involvement are illustrated. Familiarity with the imaging manifestations that are diagnostically specific for lymphoma is important because imaging plays an important role in the noninvasive management of disease. Lymphomas frequently involve nodal and extranodal structures malogna the abdomen and pelvis [ 23 ]. HD is usually almost entirely confined to maliigna lymph nodes [ 45 ]. In decreasing order of frequency, the spleen, liver, gastrointestinal tract, pancreas, abdominal wall, genitourinary tract, adrenal, peritoneal cavity, and biliary tract are involved [ 2 ].
Nodal disease can be solitary or more commonly multiple [ 3 ]. Solitary mass type of nodal lymphoma includes singular enlarged LN and fusion of multiple enlarged LN Figure 1.
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CT usually shows a huge round mass or a lobular homogeneous density mass with uniform enhancement [ 3 ]. Multiple-nodular type of lymphoma, the most frequently seen, can be characterized by enlarged LN with regional distribution Figures 2 and 3. Enlarged Likfoma can be fused together and form a huge mass and can be seen on CT as uniform density lesions with mild homogenous enhancement [ 3 ]. Figures 4 and 5 illustrate mesenteric lymph nodes.
The confluence of enlarged LN of HD is seldom seen The CT manifestations of nodal disease before and after radiochemotherapy are different, including changes in internal nodal characteristics. Increase in heterogeneous or rim enhancement of LN due to intranodular necrosis after treatment and calcifications of lesions may occur Figure 7 [ 3 ].
Extranodal involvement except in the spleen and thymus indicates stage IV HD.
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. Also the extent of extranodal involvement must be evaluated because it is considered prognostic [ 5 ]. CT is the preferred modality, although ultrasonography and MR imaging may also be limfoja.
CT is preferred for evaluating hepatic lymphoma and diagnosing gastric lymphoma and renal or perirenal masses [ 5 ]. FDG positron emission tomography PET imaging zdalah been shown to be an important technique for both staging and follow-up of nodal and extranodal lymphomas [ 4 ].
The patterns of involvement include diffuse infiltration, with or without splenomegaly, and focal nodules [ 2 ]. Diffuse infiltration may be present in spleens of normal size. Marked splenomegaly almost always indicates infiltration.
Nodules are characteristically hypoechoic at US Figure 9but very small deposits may not be detected. At CT, images demonstrate low attenuation Figures 10111213and 14 malihna reduced contrast material CM enhancement compared with normal splenic tissue [ 58 ]. 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 [ 2 ].
The sensitivity of the combined approach is higher than that of either technique alone [ 7 ]. Primary hepatic HD is very rare [ 5 ]. However, secondary liver involvement is fairly common and is usually associated with lymph node disease.
HD of the liver is almost invariably associated with disease of the spleen Figure Focal hepatic lymphoma appears as circumscribed nodules that are hypoechoic and show no posterior acoustic enhancement on US. On contrast-enhanced CT, the nodules are low attenuation Figures 17 and 18and 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 [ 28 ].
HD rarely involves the gastrointestinal GI tract. Primary HD of the GI tract usually involves a single site. Multiple sites are rarely involved in disseminated HD [ 5 ].
Malifna stomach, small bowel, pharynx, large bowel, and esophagus are involved in decreasing order of frequency [ 2 ]. However primary gastric HD is extremely rare. The patterns of gastric involvement include polypoidal mass, diffuse or focal infiltration, ulcerative lesion, or mucosal nodularity [ 2 ].
The infiltrating form is the most common Figure 20 and may be difficult to differentiate from scirrhous carcinoma. CT demonstrates gastric wall thickening with a smoothly lobulated outer border [ 5 ].
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. The patterns of limfmoa bowel involvement include solitary or multiple nodules, circumferential wall thickening Figure 21 with or without aneurysmal dilatation, and direct extension from mesenteric nodes [ 210 ].
HD of the colon is uncommon [ 510 ]. The cecum and rectum are most commonly involved [ 10 ].
The patterns of large bowel involvement include bulky polypoidal mass, infiltrative tumor, and aneurysmal dilatation Figures 2223and 24 [ 2 ].
In contrast to GI adenocarcinoma, lymphoma is more likely to involve multiple and longer segments of gut and is less likely to cause bowel obstruction. MRI is used in local staging of rectal cancers. Lymphoma usually has homogeneous intermediate signal intensity on T1-WI, heterogeneous hyperintensity on T2-WI, and mild-to-moderate enhancement after Gd injection [ 10 ]. 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 [ 1011 ].
Appendiceal lymphoma may present clinically as acute appendicitis [ 11 ].
What Is Non-Hodgkin Lymphoma?
Pancreatic HD is extremely rare and, in almost all cases, secondary to contiguous lymph node disease [ 512 ]. Because the pancreas has no definable capsule, it may be difficult to distinguish adjacent Malligna disease from intrinsic pancreatic lifoma [ 5 ].
The patterns of involvement include a circumscribed mass and diffuse glandular enlargement mimicking acute pancreatitis. Although bile duct obstruction may occur, moderate-to-severe dilatation of the main pancreatic duct is uncommon [ 12 ].
Vascular invasion, maligha atrophy distal to the tumor, and tumor calcification and necrosis are unusual adaalh initial presentation. These features can help to differentiate pancreatic lymphoma from adenocarcinoma [ 2 ]. On CT, two different morphologic patterns are seen: Intrinsic involvement of genitourinary GU organ systems at presentation is rare [ 5 ]. The kidney is the most commonly involved part of the GU tract [ 213 ].
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 [ 5 ]. The patterns of renal involvement, in descending order of frequency, include multiple circumscribed masses Figure 27direct infiltration from adjacent nodes, a solitary mass, an isolated perinephric mass Figure 28and diffuse infiltration Figure 29 [ 213 ].
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 [ 2 ].
Renal cell carcinomas can often be differentiated from lymphoma by malina hypervascular enhancement pattern [ 2 ]. The ureter is often affected by involved retroperitoneal nodes, but primary involvement of the ureter by lymphoma is rare.
Bladder involvement is also extremely rare [ 5 ]. The avalah of bladder involvement include circumscribed solitary or multiple masses and diffuse infiltration [ 2 ]. The most common form of testicular lymphoma is diffuse large B-cell lymphoma. Secondary involvement of the testis by NHL is more common than primary extranodal disease [ 14 ]. Adwlah patterns of testicular involvement include focal masses and diffuse infiltration with or without testicular enlargement [ 214 ].
The patterns of involvement include a rounded circumscribed homogeneous mass and an enlarged adrenal gland that maintains its normal shape [ 2 ]. Peritoneal lymphomatosis is afalah rare clinical presentation that is often associated with high-grade primary gastrointestinal NHL and is radiologically indistinguishable from peritoneal limfomma [ 215 ].
The patterns of involvement include discrete nodules, a diffuse infiltrative mass, and ascites Figure Exudative ascites from peritoneal lymphomatosis shows high attenuation because of the increased proteinaceous content. Diffuse lymphomatous infiltration of the mesentery produces a stellate appearance of the mesentery and causes fixation of the small bowel loops [ 2 ].
Lymphoma – Wikipedia
The patterns of involvement of the gallbladder include an intraluminal polypoidal mass, a large mass replacing the gallbladder, and diffuse mural thickening [ 2 ]. The patterns of involvement of the bile ducts include a biliary stricture mimicking cholangiocarcinoma and a focal mass [ 2 ]. Lymphoma may involve the malignq wall by direct extension from bone or may occur separately in the malitna, subcutaneous fat, or skin from hematogenous adalahh [ 2 ]. Lymphoma is the second most common neoplasm associated with AIDS.
In addition, ARL have a striking predilection for extranodal areas of involvement, and the GI tract is the most common extranodal site [ 15 ]. ARL may affect any abdominal organ, most commonly LN, the GI tract, liver, kidney, adrenal gland, omentum, and abdominal wall. The appearance may adallah from one or a few large low-attenuation masses to multiple small nodules.
Hepatomegaly is common in patients with Malignq, and occasionally a large liver may harbor lymphoma without focal lesions evident on CT [ 1617 ]. Single or multiple low-attenuation foci may be present. Splenomegaly is quite common in AIDS and is not predictive of involvement with lymphoma [ 17 ]. Adenopathy, especially retroperitoneal and limfpma, is a common manifestation of abdominal ARL.
Suspicion of neoplasm or specific infection is limited to patients with larger nodes, nodes in other locations, or large clusters of smaller nodes. If nodes have low-attenuation centers, mycobacterial infection, rather than lymphoma, is likely [ 17 ]. The omentum may be grossly infiltrated with lymphoma as one manifestation of peritoneal lymphomatosis [ 1617 ]. Focal masses of ARL may be seen in the stomach, small bowel, or colon.
Masses in the GI tract may be isolated findings, but evidence of disease elsewhere is common. 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 [ 1718 ].
Focal masses of ARL in adlaah kidney are not as common as in the liver or spleen. One or more renal masses may be seen.