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Findings: 1) Small bowel follow through demonstrates mass effect on bowel loops within the abdomen with displacement of bowel loops to the periphery of the abdominal cavity. There is also nodularity within the small bowel and aneurysmal dilatation of the small bowel near the junction of the duodenum and jejunum.
2) CT scan demonstrates large amount of soft tissue mass attenuation in the retroperitoneum and periaortic region.
Diagnosis: Non-Hodgkin's lymphoma, Stage IIIB large cell lymphoma.
Discussion: The gastrointestinal tract is the most common extranodal site of all lymphomas. The stomach, small intestine, and colon are the most common sites of involvement in order of descending frequency. This patient's small bowel involvement was diagnosed with endoscopically-guided biopsy.
On upper gastrointestinal barium examination, gastrointestinal lymphoma may produce small nodules or may be bulky with rolled elevated borders. Lymphomatous involvement of the gastrointestinal tract is submucosal until the tumor outgrows its blood supply. At that time, mucosal ulceration, perforation, and possibly abscess formation may occur. Diffuse infiltration of the bowel wall may produce circumferentially featureless bowel or regions of thick folds. Marked narrowing of the bowel lumen is uncommon since non-Hodgkin's lymphomas usually do not produce a marked desmic plasmic reaction. Lymphomatous involvement of the bowel may cause denervation which gives the aneurysmally dilated appearance of the bowel as seen in this case.
References:
Smith C, Kubicka RA, Thomas CR, Jr. Non-Hodgkin's lymphoma
of the gastrointestinal tract. Radiographics 1992;12:887-899.
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