Lymphoma

Lymphoma represents 20% of primary small intestinal malignancies. Clinical presentation is variable, depending on whether involvement is primary or secondary, or whether it is preceded by other disorders, such as adult celiac disease, immunoproliferative disease or immunodeficiency syndromes. Radiological appearances mirror the pattern of growth. Enteroclysis can define a wide spectrum of features, including luminal narrowing with mucosal destruction, multiple intra-luminal polypoid filling defects, broad-based ulceration, aneurysmal dilatation, a large excavated mass and fistula formation. Infiltrative lymphomas may cause thickening of the intestinal wall without eliciting a desmoplastic reaction. A combination of different signs is rather frequent and multi-centricity of involvement is seen in almost one fourth of patients. CT appearances of intestinal lymphoma are also variable and may be categorized as aneurysmal, nodular, ulcerative and constrictive, while mesenteric involvement will usually feature as a conglomerate mass of mesenteric/retroperitoneal tissue, or a 'Sandwich-like' complex, due to encasement of vessels from enlarged mesenteric lymph nodes. Radiologic differential diagnosis include adenocarcinoma, Crohn's disease, and, less often, malignant GIST and metastatic melanoma.

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