Radiology plays an important role in evaluating gastrointestinal lymphoma. Primary gastrointestinal lymphoma arises in the lymphatic tissue of the bowel rather than lymph nodes. Common sites of involvement include the stomach, small bowel, and colon. On imaging, gastrointestinal lymphoma can appear as thickened folds, masses, strictures, or diffuse bowel wall thickening. Staging involves assessing for involvement of lymph nodes, adjacent organs, or distant metastases. Radiology is useful for diagnosis, evaluating extent of disease, and monitoring treatment response in gastrointestinal lymphoma.

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