Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Diffuse large B-cell lymphoma involving lung and descending colon
- Radiologic Findings
- A 74-year-old female admitted with fever, dyspnea, and left flank pain for one day. Chest CT shows homogeneous well defined multiple nodules in BLLs (Fig. 1). Chest CT with mediastinal setting reveals several homogemeous lymphadenopathies in both supraclavicular areas (Fig. 2). Abdominal CT was performed for evaluation of fever focus and left plank pain. Abdomen CT scan shows eccentric wall thickening with relative homogeneous enhancement in descending colon without obstruction (Fig. 3). Also there were multiple conglomerated lymphadenopathies in mesentery and left paraaortic area. Conoloscopy was done and pathologic diagnosis was diffuse large B-cell lymphoma.
- Brief Review
- The lymphomas are a diverse group of neoplastic disorder. There are divided into Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). Further subdivisions depend on the histologic type. Intrathoracic involvement is more common in HL than NHL. Diffuse large B-cell lymphoma in the most common of the NHL. It can arise in lymph nodes or outside of the lymphatic system, in the GI tract, testes, thyroid, skin, breast, bone or brain.
Lymphoma may involve any nodal chain in the body, and enlarged nodes are most common manisfestation on CT scans. Regardless of the area of involvement, nodal involvement of lymphoma has attenuation similar to muscle and homogeneous attenuation on CT scan.
Involvement of the lung parenchyma at the time of initial diagnosis is more common in HL than NHL. The patterns of lymphomatous involvement of the lung parenchyma are variable. In a review of the CT findings in 31 patients with pulmonary parenchymal lymphoma, the most common CT findings were nodules or mass-like consolidation larger than 1 cm (68% of patients) and small nodules less than 1cm (61%). Other manifestations include GGO, thickening of the interlobular septa, and occasionally endobronchial lesions. One pattern consists of single or multiple nodules similar to those seen in metastatic disease. The other patterns consist of mediastinal of hilar adenopathy with direct extension along lymphatic vessel into the lung parenchyma.
Extranodal lymphoma in GI tract occurs in 10-30% of all patients with NHL. In contrast to adenocarcinoma arising from GI tract, lymphoma is more likely involve multiple and longer segments of gut and is less likely to cause bowel obstruction.
- References
- 1. Lee KS. Non-Hodgkin’s lymphoma. In: Muller NL, Silva IS. Imaging of the chest. Saunders, Philadelphia, 2008 pp595-615.
2. CT of lymphoma: Spectrum of Disease. RadioGraphics 1991;11:647-669
3. Patters of Lymphadenopathy in Thoracic Malignancies RadioGraphics 2004;24:419-434
4. Lymphoma of the lung: CT Findings in 31 Patients. AJR 1991;156:711-714
- Keywords
- Lung, Lymphproliferative disorder, Lymphoma,