Colonic Lymphoma

Cheryl Ann Sadow, MD - Case Coordinator
Kemi Babagbemi, MD - Radiology Discussion
Frank S David, MD, PhD - Pathology Discussion
Pablo R Ros, MD, MPH - Attending Radiologist

March 25, 2002

Presentation

Imaging Findings

Abdominal computed tomograms (CT) demonstrate a rounded cecal mass, perhaps arising from within the lumen and causing a filling defect. No stranding is visible, but the mass does seem to extend to the appendix.

Differential Diagnosis

Diagnosis

Discussion

An image of the colectomy specimen clearly demonstrates the 4 cm mass protruding into the cecal lumen. The appendix is involved, and its wall is thickened. The enlarged nodes ranged up to 2.5 cm. Mantle cell lymphoma was diagnosed by immunostaining.

A couple of polyps—adenomas—were discovered incidentally during the evaluation.

Dr. Ros observed that the gross image clearly demonstrates what was seen on the CT—a smooth, round mass with just a little ulceration, extending to the appendix.

Radiology Discussion

The first question to consider when evaluating a soft tissue mass in the cecum is: is it inflammatory, neoplastic, or non-neoplastic? If characteristics suggest an inflammatory process, the differential diagnosis should include diverticulitis, appendicitis, or typhlitis with associated abscesses. If a non-neoplastic entity is suspected, and the patient is a woman, endometriosis (usually extrinsic) should be considered. The most common neoplastic possibilities include adenocarcinoma. lymphoma, leiomyoma, leiomyosarcoma, and metastases.

Colonic lymphoma is less common than lymphoma involving the stomach or small bowel. In fact, lymphoma represents less than 1% of all colonic neoplasms, although it is found with increased frequency in patients with AIDS, Crohn’s disease, and ulcerative colitis. It is also more common in men than in women, and typically occurs in patients between the ages of 50 and 70 years.When present in the colon, lymphoma most commonly involves the cecum and the rectum, and is usually of the Non-Hodgkins type.

Forms include:

• nodules that can ulcerate and cause perforation
• discrete masses, usually without obstruction but may cause intussussception
• focal or diffuse infiltration of the colonic wall causing fold thickening
• aneurysmal dilatation by destruction of the innervation

Prognosis depends on tumor bulk as defined by staging.

Ann Arbor Staging of GI Lymphomas (Modified by Musshoff K, Strahlentherapie 1977; 153:219-21)

• Stage IE: Confined to the wall of the stomach or bowel
• Stage II1E: Regional lymph nodes contiguous to primary site
• Stage II2E: Regional lymph nodes not contiguous to primary site
• Stage III: Lymph nodes on both sides of the diaphragm, spleen (IIIS) or both (IIIE&S)
• Stage IV: Bone marrow or other non-hematolymphoid organ

References

Levy A. AFIP Course Syllabus , Gastrointestinal section: Abdominal Lymphoma.

Weissleder R, Rieumont M, Wittenberg J. Primer of Diagnostic Imaging . 2nd edition. St Louis, MO: Mosby; 1997:174.

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