1. GIT LYM
PHOM
AS

2. Role Of Radiology in
Gastrointestinal Lymphoma

3. DEFINITION
 Lymphoma Is A Type Of Cancer That Arises
In the Immune Cells Called As Lymphocytes.
 Extra nodal Lymphoma Is Term Used To
Describe Lymphomas Occuring Outside The
Lymphatic Tissues.

4. INTRODUCTION
 Distinct group of lymphoma that primarily arises in lymphoid
tissue of the bowel rather than in lymph nodes
 G I lymphoma may either represent secondary involvement by
systemic disease or primary malignancy confined to the GI tract
 GIT-lymphoid Elements Seen In The Lamina Propria and Sub
Mucosa
 Secondary GI Involvement Is Common
 Primary Lymphomas Involve Only One Site

5. Five Criteria Put Forth By Dawson et al
To Diagnose Primary GI Lymphomas
 No Palpable Superficial Lymph Nodes
 Normal CXR
 WBC Count are Normal
 At Laparotomy Alimentary Tract Is Involved With Lymph node
Involvement if Any confined to the drainage area of gut
involved
 No Spleen Or Liver Involvement
 Advanced Stages Mimic Secondary GI Lymphoma

6. Gastrointestinal Lymphoma
Most Commonly Non-hodgkin Lymphomas That Are High Grade
Large Cell Or Immunoblastic Cell Types
 Burkitt More Common In Pediatric Patients
 Most Common Symptoms: Abdominal Pain, Weight Loss, fever,
Anemia
T-cell Lymphoma If In GIT Occurs In Small Bowel
(64%)esp.Duodenum+jejunum.

7. Oesophagus
 Esophagus: Least common site within GI tract
 Accounts for only about 1% of all cases
 Usually non-Hodgkin & less commonly Hodgkin
 Patients almost always have generalized lymphoma
 Primary esophageal lymphoma seen in AIDS cases

8. Imaging
 Usually contiguous spread from gastric
 cardia/fundus to distal esophagus
 Polypoid or ulcerated mass or infiltrating stricture
 Submucosal infiltration (less common)
 Enlarged, tortuous longitudinal folds mimicking varices
Diagnosis: Endoscopy with deep esophageal biopsy

9. MULTIPLE ESOPHAGEAL NODULES

10.  gastric lymphoma represents the most common
site of extra nodal lymphoma, accounting for 25%
of all such lymphomas, 50% of all gastrointestinal
lymphomas, but comprise only 1-5% of all gastric
malignancies .
 Typically primary gastric lymphoma occurs in
adults in the 6th decade of life, without gender
predilection. Secondary gastric lymphoma matches
the demographics of the underlying lymphoma.
Gastric lymphoma

11. Pathology
Three distinct types of gastric lymphoma are recognized :
low-grade MALT lymphoma : 60% of all primary gastric
lymphomas
primary sporadic lymphoma : vast majority are B-cell non-
Hodgkins lymphoma
secondary involvement of the stomach by systemic lymphoma
(usually high grade)
Mucosa-associated lymphoid tissue (MALT) lymphoma and
are strongly associated with Helicobacter pylori (85 - 98% of
cases). These are low-grade lymphomas and may regress following
treatment of Helicobacter infection .

12. Radiographic features Gastric
lymphoma
Fluoroscopy : Barium meal
Appearances vary from normal, to grossly abnormal.
Possible appearances include:
 bull's eye appearance due to central ulceration
 filling defects
 thickened gastric rugae
 linitis plastica

13. Computed tomography
Typically gastric lymphomas demonstrate marked
thickening of the stomach wall (2-4cm) with extensive
lateral extension of the tumour (i.e. along the wall of
the stomach) representing submucosal spread.

14.  Submucosal spread may
 Encompasses the majority of the stomach giving a
linitis plastica appearance.
 Can extend across the pylorus into the duodenum
and superiorly into the oesophagus.
 uncommon for lymphoma to result in
gastric outlet obstruction

15. UPPER GI SERIES SHOWS MASSIVE NODULAR THICKENINGS
OF GASTRIC WALL/FOLDS; LYMPHOMA

16. PERSISTENT COLLECTION OF CONTRAST WITH
MUCOSAL ULCERATION

18. LINITIS PLASTICA—SMALL NON DISTENSIBLE
STOMACH

20. BULL’S EYE LESION

21. THICKENED GASTRIC FOLDS

26. GI lymphoma staging
 I: Tumor confined to bowel wall
 II: Limited nodal spread to local nodes
 III: Widespread nodal mets
 IV: Spread to bone marrow, solid viscera,
liver

27. Small bowl
 1/5 of all small bowel malignancies.
 Most common malignant small bowel tumor.

 Multiple sites involvmentin1/5.
Most common cause of INTUSSUSEPTION in
children>6yrs

28.  Location
 ileum(51%)
 jejunum(47%)
 duodenum(2%)
 Site
payer patches

29.  Radiographic findings;
 Nodular pattern
 Single mass
 Infiltrating pattern
 Exophytic
 Mesenteric/retroperitoneal Adenopathy

30. Duodenal Lymphoma---Bulky Soft Tissue Mass
Infiltrating Submucosa

32. Small Intestinal Mass

35. Colon
 Less Comonly Involved Than Stomach/Small Bowel
1.5% Of All Abdominal Lymphomas
 Location
Cecum Mostly
 Presentation
Single mass>diffuse infiltrating>polypoid
Paradoxical dilatation
Gross mural circumferential thickening
Massive regional+distantmesenteric+retroperitoneum
adenopathy.

36. APPENDICULAR LYMPHOMA--- SOFT TISSUE
MASS NEAR TIP OF CAECUM

37. Mesentry And Omentum
 Infiltration and thickenining of mesentry
 Omental caking
 Nodular or strand like soft tissue density
 Calcified foci
 Rounded mass

39. Peritoneal And Omental Mass

40. Small Intestine .. Fold Thickening Luminal
Narrowing

41. Thickened Mucosal Folds With Ulceration

43. THANK YOU