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Stage IV Non-Hodgkin’s Lymphoma

USU Teaching File MUTF - MedPix

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Stage IV Non-Hodgkin’s Lymphoma

History: A 33 y/o female presented with 2 weeks of post-prandial RLQ pain and loose bowel movements. RUQ ultrasound and CXR were within normal limits. The pt returned 6 weeks later with increasing abdominal pain and a CT of the chest/abdomen/pelvis was ordered.

Findings: CT of chest/abdomen/pelvis with IV and oral contrast: The liver, spleen, gallbladder and kidneys are WNL. Multiple enlarged lymph nodes are present along the superior mesenteric lymphovascular bundle and there is moderate diffuse lymphadenopathy of the abdomen. A discrete mass, measuring 5.8x4.7cm, encases adjacent small bowel loops in the right paramedian pelvis. A second mass, also encasing small bowel, is present in the left lower quadrant and measures 1.9cm along the enlarged lymph nodes. There is a clustered nodal mass, surrounding loops of small bowel adjacent to the abdominal aorta, above the level of the bifurcation, which measures 4.6cm across. A small amount of free fluid is present in the pelvis. There is no evidence of small bowel obstruction.

Ddx: Infectious process such as tuberculosis or a neoplastic process such as lymphoma or metastatic disease (breast cancer and melanoma are most likely to metastasize to the small bowel). Less likely is an inflammatory process such as Crohn’s, as the terminal ilium is not involved.

Dxhow: Stage IV Non-Hodgkin’s Lymphoma was diagnosed by lymph node biopsy. Pathology demonstrated a large B-cell lymphoma of the small bowel.

Exam: Physical exam was unremarkable, notably there was no abdominal pain to palpation and no sonographic Murphy’s sign. Labs demonstrated anemia (Hg 9.3, Hct 28.2), and low iron (6), iron saturation (1.7), and ferritin (9.4) levels. Stool was hemocult positive for occult blood. Chemistries and LFT’s were within normal limits as were H.pylori antibody, AFP and CEA levels. ESR was 17.

No MeSH data available.


CT of chest/abdomen/pelvis with IV and oral contrast:  The liver, spleen, gallbladder and kidneys are WNL.  Multiple enlarged lymph nodes are present along the superior mesenteric lymphovascular bundle and there is moderate diffuse lymphadenopathy of the abdomen.  A discrete mass, measuring 5.8x4.7cm, encases adjacent small bowel loops in the right paramedian pelvis.  A second mass, also encasing small bowel, is present in the left lower quadrant and measures 1.9cm along the enlarged lymph nodes.  There is a clustered nodal mass, surrounding loops of small bowel adjacent to the abdominal aorta, above the level of the bifurcation, which measures 4.6cm across.  A small amount of free fluid is present in the pelvis.  There is no evidence of small bowel obstruction.
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MPX1814_synpic18908: CT of chest/abdomen/pelvis with IV and oral contrast: The liver, spleen, gallbladder and kidneys are WNL. Multiple enlarged lymph nodes are present along the superior mesenteric lymphovascular bundle and there is moderate diffuse lymphadenopathy of the abdomen. A discrete mass, measuring 5.8x4.7cm, encases adjacent small bowel loops in the right paramedian pelvis. A second mass, also encasing small bowel, is present in the left lower quadrant and measures 1.9cm along the enlarged lymph nodes. There is a clustered nodal mass, surrounding loops of small bowel adjacent to the abdominal aorta, above the level of the bifurcation, which measures 4.6cm across. A small amount of free fluid is present in the pelvis. There is no evidence of small bowel obstruction.


Stage IV Non-Hodgkin’s Lymphoma

USU Teaching File MUTF - MedPix

CT of chest/abdomen/pelvis with IV and oral contrast:  The liver, spleen, gallbladder and kidneys are WNL.  Multiple enlarged lymph nodes are present along the superior mesenteric lymphovascular bundle and there is moderate diffuse lymphadenopathy of the abdomen.  A discrete mass, measuring 5.8x4.7cm, encases adjacent small bowel loops in the right paramedian pelvis.  A second mass, also encasing small bowel, is present in the left lower quadrant and measures 1.9cm along the enlarged lymph nodes.  There is a clustered nodal mass, surrounding loops of small bowel adjacent to the abdominal aorta, above the level of the bifurcation, which measures 4.6cm across.  A small amount of free fluid is present in the pelvis.  There is no evidence of small bowel obstruction.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1814&req=5

MPX1814_synpic18908: CT of chest/abdomen/pelvis with IV and oral contrast: The liver, spleen, gallbladder and kidneys are WNL. Multiple enlarged lymph nodes are present along the superior mesenteric lymphovascular bundle and there is moderate diffuse lymphadenopathy of the abdomen. A discrete mass, measuring 5.8x4.7cm, encases adjacent small bowel loops in the right paramedian pelvis. A second mass, also encasing small bowel, is present in the left lower quadrant and measures 1.9cm along the enlarged lymph nodes. There is a clustered nodal mass, surrounding loops of small bowel adjacent to the abdominal aorta, above the level of the bifurcation, which measures 4.6cm across. A small amount of free fluid is present in the pelvis. There is no evidence of small bowel obstruction.

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Stage IV Non-Hodgkin’s Lymphoma

History: A 33 y/o female presented with 2 weeks of post-prandial RLQ pain and loose bowel movements. RUQ ultrasound and CXR were within normal limits. The pt returned 6 weeks later with increasing abdominal pain and a CT of the chest/abdomen/pelvis was ordered.

Findings: CT of chest/abdomen/pelvis with IV and oral contrast: The liver, spleen, gallbladder and kidneys are WNL. Multiple enlarged lymph nodes are present along the superior mesenteric lymphovascular bundle and there is moderate diffuse lymphadenopathy of the abdomen. A discrete mass, measuring 5.8x4.7cm, encases adjacent small bowel loops in the right paramedian pelvis. A second mass, also encasing small bowel, is present in the left lower quadrant and measures 1.9cm along the enlarged lymph nodes. There is a clustered nodal mass, surrounding loops of small bowel adjacent to the abdominal aorta, above the level of the bifurcation, which measures 4.6cm across. A small amount of free fluid is present in the pelvis. There is no evidence of small bowel obstruction.

Ddx: Infectious process such as tuberculosis or a neoplastic process such as lymphoma or metastatic disease (breast cancer and melanoma are most likely to metastasize to the small bowel). Less likely is an inflammatory process such as Crohn’s, as the terminal ilium is not involved.

Dxhow: Stage IV Non-Hodgkin’s Lymphoma was diagnosed by lymph node biopsy. Pathology demonstrated a large B-cell lymphoma of the small bowel.

Exam: Physical exam was unremarkable, notably there was no abdominal pain to palpation and no sonographic Murphy’s sign. Labs demonstrated anemia (Hg 9.3, Hct 28.2), and low iron (6), iron saturation (1.7), and ferritin (9.4) levels. Stool was hemocult positive for occult blood. Chemistries and LFT’s were within normal limits as were H.pylori antibody, AFP and CEA levels. ESR was 17.

No MeSH data available.