Small bowel lymphoma is the most common small bowel malignancy, accounting accounts for ~25% of all primary small bowel malignancies and ~40% of all primary gastrointestinal lymphomas.
Small bowel lymphoma is most commonly secondary extranodal involvement in widespread systemic lymphoma. When primary it is seen predominantly in well-defined patient groups, and the demographics, therefore, match those groups. Predisposing conditions include 1:
- coeliac disease
- organ transplant (see post-transplant lymphoproliferative disorder (PTLD)
- Helicobacter pylori positive patients
The presentation is variable and includes 1:
The type of lymphoma depends on the underlying predisposing condition.
- H. pylori: mucosa-associated lymphoid tissue lymphoma (MALToma)
- PTLD: polyclonal B-cell non-Hodgkin's lymphoma (EBV-associated)
- HIV: B-cell non-Hodgkin's lymphoma 3, overall most common type
- T-cell lymphomas are seen but are uncommon 5; they have a greater tendency to perforate
Typically, small-bowel lymphoma involves a single loop of bowel, with 5-20 cm of its length demonstrating 3:
- bowel wall thickening: 1-7 cm
- aneurysmal (or pseudoaneurysmal) dilatation (30%): occurs due to the replacement of muscularis by tumour or infiltration of myenteric nerve plexus 6
Despite the extensive involvement, small bowel obstruction is uncommon because of lack of desmoplastic reaction, and perforation is rare.
Regional lymph node enlargement in approximately 50% of cases.
Less frequently, the disease may manifest as a solid mass lesion (polypoidal/excentric). Differentiation from adenocarcinoma may be difficult. However, the presence of extensive retroperitoneal lymphadenopathy and splenomegaly favours lymphoma, whereas adjacent fat infiltration supports adenocarcinoma.
Treatment and prognosis
Most frequently, the involved segment is resected, with subsequent chemoradiotherapy 2.
- 1. Posner Mitchell C., Everett E. Vokes, Ralph R. Weichselbaum and American Cancer Society. Cancer of the upper gastrointestinal tract. PMPH-USA, 2002. ISBN: 1550091018, 9781550091014.
- 2. Ha CS, Cho MJ, Allen PK et-al. Primary non-Hodgkin lymphoma of the small bowel. Radiology. 1999;211 (1): 183-7. Radiology (full text) - Pubmed citation
- 3. Balthazar EJ, Noordhoorn M, Megibow AJ et-al. CT of small-bowel lymphoma in immunocompetent patients and patients with AIDS: comparison of findings. AJR Am J Roentgenol. 1997;168 (3): 675-80. doi:10.2214/ajr.168.3.9057513 - Pubmed citation
- 4. Rubesin SE, Gilchrist AM, Bronner M et-al. Non-Hodgkin lymphoma of the small intestine. Radiographics. 1990;10 (6): 985-98. Radiographics (abstract) - Pubmed citation
- 5. Byun JH, Ha HK, Kim AY et-al. CT findings in peripheral T-cell lymphoma involving the gastrointestinal tract. Radiology. 2003;227 (1): 59-67. Radiology (full text) - doi:10.1148/radiol.2271012129 - Pubmed citation
- 6. Ghai S, Pattison J, Ghai S et-al. Primary gastrointestinal lymphoma: spectrum of imaging findings with pathologic correlation. Radiographics. 2007;27 (5): 1371-88. doi:10.1148/rg.275065151 - Pubmed citation
- overview of lymphoma
WHO classification of tumours of haematopoietic and lymphoid tissues
- Hodgkin lymphoma
mature B-cell lymphoma
- Burkitt lymphoma
- follicular lymphoma
- lymphoplasmacytic lymphoma (Waldenström's macroglobulinaemia)
- lymphomatoid granulomatosis
- mantle cell lymphoma
- mature T-cell and NK-cell lymphoma
- post-transplant lymphoproliferative/lymphoproliferation disorders
- mature B-cell lymphoma
- location-specific lymphomas
- central nervous system
- head and neck lymphoma
- thoracic lymphoma
- gastrointestinal lymphoma
- hepatobiliary lymphoma
- genitourinary lymphoma
- musculoskeletal lymphoma
- cutaneous lymphoma
- lymphoma staging