Abdominal Lymphoma Research Articles

Splenosis simulating an abdominal lymphoma

Splenosis, an autograft of splenic tissue, may occur after a traumatic spleen rupture or splenectomy. Usually asymptomatic, this pathology may uncommonly produce symptoms which justify radiologic investigations. We are presenting the case of a young boy with a Wiskott Aldrich syndrome and who developed splenosis simulating an abdominal lymphoma.

Primary Burkitt's Lymphoma of the Appendix

Appendicitis is a very rare presenting symptom of abdominal Burkitt's lymphoma. Only four cases have previously been identified in the literature, all of them males. This is the first reported case of a female as well as the youngest and is representative of the therapeutic considerations in this unusual manifestation of the disease.

A new treatment protocol for childhood non-Hodgkin's lymphoma: preliminary evaluation.

Between November 1986 and July 1988, 21 consecutively diagnosed children with nonlocalized abdominal lymphoma (Murphy's stage III and IV without CNS disease) were eligible for treatment with a multidrug chemotherapy schedule. The induction phase was the same for all (fractionated cyclophosphamide, intermedian-dose methotrexate [Mtx], vincristine [Vcr], and prednisone). After that the children were randomized to repeat the same scheme or intercalate teniposide (VM26) plus cytarabine (AraC) with the induction-phase scheme. All of them were treated for only 6 months. The protocol approved to be very effective with 85% remission in all the children and 94% survival in patients surviving the induction phase. The toxicity was acceptable, also considering the characteristics of our population (malnourished children). The group VM26 and AraC had few hospital admissions in spite of the small number of children because they received VM26 and AraC as outpatients. The sale purpose of the present study is to report that with a few simple procedures such as hydration, alkalinization, and drug fractionation, the chemotherapy schemes used can bring about a dramatic improvement in short-term survival.

La leucoencéphalopathie multifocale progressive. Apport de l'imagerie par résonance magnétique nucléaire

Progressive multifocal leucoencephalopathy is a white matter infection caused by a papovavirus. Immunocompromised patients are predominantly affected. We report the case of a 74-year old woman with abdominal lymphoma resistant to chemotherapy. The diagnosis was suggested by cerebral CT and NMR images and was confirmed at postmortem pathological examination. The contribution of complementary examinations to the diagnosis is discussed in the light of recently published studies.

Renal Sonography in Childhood Lymphoma

The sonographic manifestations of 20 childhood abdominal biopsy-proved lymphomas were presented. Thirteen cases showed positive renal sonographic findings such as renomegaly, hyperechoic renal cortex, focal hypoechoic mass and hydronephrosis. The incidence of renal involvement was high in lymphoma detected by ultrasound. There was no difference between sonographic findings of Hodgkin and non-Hodgkin lymphoma. The ultrasound findings may be confirmed with gallium scanning. Ultrasound was more accurate in detecting renal lesions in lymphoma than computed tomography.

Salmonellosis mimicking abdominal lymphoma in a young boy

We report on a child intra-abdominal lymphadenopathy and hepatosplenomegaly due to salmonellosis, whose initial diagnosis was erroneously based on computed tomography (CT) findings suggestive of abdominal lymphoma

Abdominal Lymphoma - the Place for Surgery

Gastrointestinal lymphoma (GIL) is rare but may be cured by surgery and chemotherapy. Because symptoms frequently mimic common abdominal conditions, presentation is often to a surgeon. Fifty-five patients with GIL were treated between 1975 and 1984: all underwent operations before the correct diagnosis was made, 22 (40%) as emergencies. Misdiagnosis in 23 (42%) led to a delay in correct treatment of greater than or equal to 6 months from the start of symptoms: in 17 (31%) the delay was greater than or equal to one year. Endoscopy and radiology were inaccurate and suggested peptic ulceration, Crohn's disease or irritable bowel syndrome. The site of disease was usually stomach and duodenum (26, 47%) or ileum and jejunum (29, 53%). The extent of surgical resection was associated with survival at greater than or equal to 3 years-in 16 (29%) who underwent 'complete resection' 14 survived, but only one of 28 survived when the operation was limited to diagnostic biopsy (P less than 0.0001). Most deaths occurred within one year of operation, commonly from perforation or haematemesis from residual mural disease during chemotherapy. In 5 of 11 patients who had biopsy only, CT scans suggested localized disease, and 'complete resection' was achieved at a second laparotomy. Complete resection should be attempted wherever possible before chemotherapy. The place for surgeons with experience is clearly central to the management of this disease.

Phase II study of ifosfamide as a single drug for relapsed paediatric patients

A total of 22 patients with different solid tumours refractory to previous chemotherapy were treated between May 1985 and December 1986 (osteosarcoma, 7; Wilms' tumour, 6; rhabdomyosarcoma, 2; Ewing's sarcoma, 2; non-Hodgkin's lymphoma, 2; retinoblastoma, 1; cavum lymphoepithelioma, 1; dyktioma, 1). Patients were aged between 3 and 20 years (mean, 10.6 years). There was a 3.4:1 male-to-female ratio. The treatment consisted of ifosfamide given i.v. as a single agent at a dose of 3,000 mg/m2 over 1 h on days 1 and 2. Mesna was given as a uroprotector at 600 mg/m2 every 4 h, up to a total of 13 doses. The courses were repeated every 3 weeks. Every patient except those with osteosarcoma had previously received cyclophosphamide. There were 3 (13.6%) complete responses (CRs) in 2 osteosarcomas and 1 abdominal non-Hodgkin's lymphoma, lasting 12, 8 and 2 months, respectively; 4 (18.2%) partial responses (PRs) in 2 Wilms' tumours, 1 Ewing's sarcoma and 1 abdominal non-Hodgkin's lymphoma; 4 absences of remission (ARs); and 11 (50%) cases of progressive disease (PD). In all, 81 courses were given, and the toxicities found were leukopenia (less than 2,000 leukocytes) in 15 courses, thrombocytopenia in 3, microhaematuria in 7, neurotoxicity in 8, fever in 8 and hypertension in 2. The overall response rate (31.8%) was encouraging and the toxicity, acceptable and reversible. These results demonstrate that ifosfamide should be considered for introduction into phase III protocols for the treatment of solid malignancies in children.

Extramedullary leukemia with central facial palsy originated from poorly differentiated abdominal lymphoma

An 8-year-old boy was presented with central facial palsy caused by extramedullary leukemia which had originated from poorly differentiated abdominal lymphoma. On cerebral tomographic scanning, there were adherences in the basal area of the brain. The occurrence of central facial palsy is very rare in childhood leukemia. However, in this case facial palsy was central in type and appeared as the presenting sign. The occurrence of central facial palsy was confirmed by the absence of clinical, radiological and audiological signs of peripheral involvement. The contralateral stapedius reflex test (500, 1000, and 2000 Hz) was present in this case.

Abdominal lymphoma in AIDS: evaluation with US.

The sonographic findings in 38 patients with abdominal lymphomas related to acquired immunodeficiency syndrome (AIDS) were reviewed. Thirty-three patients had non-Hodgkin lymphoma, and five had Hodgkin disease. Abnormal masses were detected with sonography in 33 patients (87%). Focal hypoechoic liver lesions up to 10 cm in diameter were visible in 17 patients. Several lesions were anechoic and septated, mimicking fluid. Adenopathy (at the retroperitoneum, mesentery, or porta hepatis) was seen in 15 patients. Other involved areas included bowel, omentum, spleen, kidney, and adrenal gland. AIDS-related abdominal lymphomas frequently cause extranodal masses that can be readily imaged with ultrasound. Ultrasound-guided fine needle aspiration biopsy allows a specific diagnosis to be made in many cases.

RAV-1 insertional mutagenesis: disruption of the c-myb locus and development of avian B-cell lymphomas

Infection of young chickens with RAV-1, a subgroup A isolate of avian leukosis virus, results in the development of lymphoid leukosis, a B-cell lymphoma characterized by provirus insertion into the c-myc locus. We report here that when 12- to 13-day-old embryos rather than 1-day-old chickens were infected with RAV-1, a novel B-cell lymphoma developed in which proviral insertions had activated expression of the c-myb gene. These tumors expressed elevated levels of a 4.5-kilobase myb-containing mRNA transcript that contained c-myb sequences not found in v-myb. The c-myc locus in these tumors appeared normal. The biological properties of the activated myb lymphoma were distinct from those of lymphoid leukosis. Metastatic disease developed within 7 weeks of infection. Distinct intermediate pathogenic stages with preneoplastic and primary neoplastic lesions were not detected. Although bursal tissues appeared to be nonmalignant on gross examination, Southern analyses of bursal DNA revealed the presence of tumor with the same clonal origin as abdominal lymphoma masses. The dependence on embryonic infection for development of activated myb lymphoma suggests that the target cells in which c-myb is activated are found only in embryos and are distinct from those cells that give rise to lymphoid leukosis.

Fine-Needle Aspiration Cytology and Immunocytochemistry of Abdominal Non-Hodgkin's Lymphomas.

The cytomorphology and immunologic characteristics of cells obtained by fine-needle aspiration biopsy of 34 consecutive patients with abdominal lymphomas were analyzed. Nineteen patients had no previous diagnosis, while 15 had previously known or suspected lymphomas. On cytology 21 high-grade and 13 low-intermediate-grade lymphomas were diagnosed. Immunologic characterization of aspirated cells identified one T-cell and 33 B-cell neoplasms. A monoclonal light chain expression was detected in 27 of the B-cell lymphomas. The results were in good agreement with those from histologic (n = 19) and immunohistochemical (n = 5) evaluations. The value and accuracy of fine-needle aspiration cytology in conjunction with immunocytochemistry are detailed.

Celiac Sprue and Abdominal Lymphoma: Studies on the Cell-Mediated Immune Response of Peripheral Blood Lymphocytes

The development of primary abdominal lymphoma is a recognized complication of gluten-sensitive enteropathy (GSE). ln five patients with GSE plus lymphoma, the distribution and function of peripheral blood lymphocytes were determined and compared with 13 patients with GSE without lymphoma and with 28 normal control subjects. The percentage of T cells was lower in patients with GSE and GSE with lymphoma than in controls, whereas patients with GSE plus lymphoma had a significantly increased number of peripheral blood B lymphocytes when compared with GSE patients or controls. There was no difference in K cell activity or lymphocyte responses to mitogens and antigens between controls, GSE or GSE plus lymphoma patients. Prospective studies are needed in patients with GSE co investigate whether this fall in peripheral blood T cells and rise in B lymphocytes is a marker of concurrent lymphoma.

Non-Hodgkin's lymphomas in Jordanians: a histopathological study of 231 cases.

Our hospital admitted 231 patients with non-Hodgkin's lymphomas between June 1976 and November 1984. Review of these cases revealed the following profile: ages ranged from 1 to 70 years (median: 30 years), 156 males, predominantly children and adolescents, and 75 females. Diffuse histiocytic lymphoma accounted for 40.6 per cent of all cases. Seventeen patients (7 per cent) had nodular lymphomas. Fifteen patients, predominantly male children and adolescents, had lymphoblastic lymphomas and showed high association with mediastinal mass (47 per cent). Extranodal lymphomas mostly of the diffuse histiocytic subtype were diagnosed in 100 cases (43.3 per cent) and most frequently situated in the small intestine (59 cases). Burkitt's lymphoma--32 patients (14 per cent)--presented most often in male patients during the first decade of life and as an abdominal intestinal disease (19 cases). There were four cases of Mediterranean abdominal lymphoma (IPSID). Non-Hodgkin's lymphomas in Jordanians are mostly of the diffuse histiocytic type, are rarely nodular, have a high frequency of extranodal involvement and tend to occur in younger age groups. Mediterranean abdominal lymphoma is less frequent than previously thought. The use of both of the Rappaport and Lukes-Collins classifications demonstrated a high degree of reproducibility.

Distribution of abdominal and pelvic Hodgkin disease: implications for CT scanning.

Computed tomography of the abdomen and pelvis is frequently performed for the staging of abdominal and pelvic lymphoma. Certain limited CT protocols have been nearly as accurate as more complete examinations at defining the extent of lymphadenopathy and the response to therapy, with the advantages of decreased scanning time and patient radiation dose. We reviewed abdominal and pelvic CT scans and reports of 58 patients with Hodgkin disease to determine whether the entire abdomen and pelvis must always be scanned in such patients. Pelvic adenopathy without concurrent abdominal adenopathy was present in only one of 58 patients, and that patient presented clinically with inguinal adenopathy. These findings are supported by larger pathologic studies showing that Hodgkin disease always spreads contiguously. Patients with Hodgkin disease presenting above the diaphragm should undergo abdominal CT for staging; if the abdomen is normal, the pelvis need not be scanned. For Hodgkin patients with clinical or CT evidence of disease below the diaphragm, both abdomen and pelvis should be scanned.

Abdominal Lymphoma: Role of Surgery

Although patients with localized gastrointestinal lymphoma have reasonable 5-year survival rates after resection and these rates seem improved with radiotherapy and chemotherapy, long-term survival rates in patients with advanced disease remain poor. The future of therapy for patients with non-Hodgkin's lymphoma of the gastrointestinal tract lies with the multidisciplinary approach combining resection, debulking, radiotherapy, and multidrug chemotherapy.

Sonography of Abdominal Posttransplant Lymphoma

Five patients developed abdominal lymphoma an average of 89 months after successful renal transplantation. Sonographically, the lymphomas presented as bulky intraperitoneal masses or focal deposits in the liver. These lesions exhibited good sound transmission and intrinsic patterns ranging from sparse, soft echoes to coarse trabeculations. Prompt diagnosis of this serious late complication of renal transplantation is crucial.

Abdominal fine needle aspiration biopsies with CT and ultrasound guidance: Techniques, results and clinical implications

Experience with fine needle aspiration biopsy (FNAB) of solid intraabdominal masses with computed tomography and ultrasound guidance in 117 patients at a large community hospital is described. An overall accuracy of 86%, sensitivity of 86%, and specificity of 93% was obtained. FNAB was found to be safe and accurate and obviated the need for surgery in nearly 50% of patients. Further experience is required to assess the value of FNAB in solid renal masses and in abdominal lymphoma.

CT of abdominal lymphoma after renal transplantation.

Six patients aged 33-68 years developed posttransplant lymphoma of the abdomen an average of 105 months after successful renal transplantation. On computed tomography (CT), five lymphomas presented as bulky masses in intra- (four) or retroperitoneal (one) location. Infiltrative growth into transplanted kidney (three), colon (two), and retroperitoneum (one) resulted in poorly defined margins on CT. Central areas of lower attenuation presumably reflected tumor necrosis. Metastatic deposits in liver (two) and renal transplant (one) were of a focal nature. Prompt radiologic recognition of this serious late complication of renal transplantation is crucial.

Computed tomography of gastrointestinal lymphoma.

From 275 computed tomographic (CT) examinations with positive findings of abdominal lymphoma, 26 patients were found to have gastrointestinal involvement by the disease. The stomach was most commonly involved, followed by small bowel, colon, and duodenum. CT was found to be accurate in detecting wall thickening and complications such as perforation and fistulization. False-negative examinations occurred in two patients with small submucosal gastric deposits ("bull's-eye" lesions). False-positive examinations were seen in two patients with hypertrophic gastritis. The CT manifestations of gastrointestinal lymphoma, correlated with the barium study appearance, are the subject of this report.