Git lymphomas

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Git lymphomas

  1. 1. GIT LYM PHOM AS
  2. 2. Role Of Radiology in Gastrointestinal Lymphoma
  3. 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. 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. 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. 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. 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. 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. 9. MULTIPLE ESOPHAGEAL NODULES
  10. 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. 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. 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. 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. 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. 15. UPPER GI SERIES SHOWS MASSIVE NODULAR THICKENINGS OF GASTRIC WALL/FOLDS; LYMPHOMA
  16. 16. PERSISTENT COLLECTION OF CONTRAST WITH MUCOSAL ULCERATION
  17. 17. LINITIS PLASTICA—SMALL NON DISTENSIBLE STOMACH
  18. 18. BULL’S EYE LESION
  19. 19. THICKENED GASTRIC FOLDS
  20. 20. 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
  21. 21. 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
  22. 22.  Location  ileum(51%)  jejunum(47%)  duodenum(2%)  Site payer patches
  23. 23.  Radiographic findings;  Nodular pattern  Single mass  Infiltrating pattern  Exophytic  Mesenteric/retroperitoneal Adenopathy
  24. 24. Duodenal Lymphoma---Bulky Soft Tissue Mass Infiltrating Submucosa
  25. 25. Small Intestinal Mass
  26. 26. 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.
  27. 27. APPENDICULAR LYMPHOMA--- SOFT TISSUE MASS NEAR TIP OF CAECUM
  28. 28. Mesentry And Omentum  Infiltration and thickenining of mesentry  Omental caking  Nodular or strand like soft tissue density  Calcified foci  Rounded mass
  29. 29. Peritoneal And Omental Mass
  30. 30. Small Intestine .. Fold Thickening Luminal Narrowing
  31. 31. Thickened Mucosal Folds With Ulceration
  32. 32. THANK YOU

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