Git lymphomas
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  • 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
  • 17. LINITIS PLASTICA—SMALL NON DISTENSIBLE STOMACH
  • 18. BULL’S EYE LESION
  • 19. THICKENED GASTRIC FOLDS
  • 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. 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.  Location  ileum(51%)  jejunum(47%)  duodenum(2%)  Site payer patches
  • 23.  Radiographic findings;  Nodular pattern  Single mass  Infiltrating pattern  Exophytic  Mesenteric/retroperitoneal Adenopathy
  • 24. Duodenal Lymphoma---Bulky Soft Tissue Mass Infiltrating Submucosa
  • 25. Small Intestinal Mass
  • 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. APPENDICULAR LYMPHOMA--- SOFT TISSUE MASS NEAR TIP OF CAECUM
  • 28. Mesentry And Omentum  Infiltration and thickenining of mesentry  Omental caking  Nodular or strand like soft tissue density  Calcified foci  Rounded mass
  • 29. Peritoneal And Omental Mass
  • 30. Small Intestine .. Fold Thickening Luminal Narrowing
  • 31. Thickened Mucosal Folds With Ulceration
  • 32. THANK YOU