B-cell lymphoma - mesenteric mass

Case contributed by Dr Matthew Tse

Presentation

10 days upper abdominal pain and abdominal distension.

Patient Data

Age: 50
Gender: Female

CT abdomen and pelvis

CT

No previous for comparison.

Large volume ascites.

Impression of irregular relatively hyperattenuating (i.e. probably enhancing), soft tissue density mass centered within the mesentery, measuring 13.6 x 9.2 by 12.4 cm (TR x AP x CC). The mass abuts the third and fourth parts of the duodenum but no duodenal or gastric holdup demonstrated.
The mesenteric vessels course through the mass.
The superior mesenteric vein is difficult to identify within this mass, the confluence of the superior mesenteric vein and splenic vein however is normal, with patent portal vein.
Engorged mesenteric veins around the mass demonstrated, likely represents collateral venous drainage.

No enlarged retroperitoneal, nor pelvic or inguinal nodes.

The majority of the small bowel is thickened and edematous though mucosal enhancement is maintained. No frank pneumatosis.
The unprepared large bowel is grossly normal.

Normal liver, gallbladder, adrenals, kidneys, pancreas and spleen.

Imaged lung bases are clear.

Normal imaged skeleton.

Opinion:
Large mesenteric mass suspicious for a malignant process, appears centered within the mesentery itself and may represent an unusual pathology e.g. sarcoma or possibly lymphoma.
Edematous small bowel generally. The mass likely involves the mesenteric vessels though evidence of collateral venous drainage, appearances likely represent a degree of superior mesenteric venous compromise. No frank bowel ischemia at present. No perforation.

Case Discussion

An interesting case of extranodal lymphoma presenting acutely.

Solid mesenteric masses are typically malignant in nature.

Malignant mesenteric masses may either be primary (derived from mesenteric tissue e.g. desmoid and carcinoid tumors), or secondary (including lymphoma and solid organ metastases), with lymphoma being the most common cause.

 

For this patient, attempt at tissue diagnosis was initially performed endoscopically with trans-duodenal shark core biopsies. The histology was not definitive.

The patient proceeded to cytology from ascitic tap but the cell block was not supportive of lymphoma.

The patient then proceeded to laparoscopic tissue sampling which confirmed the diagnosis of large B-cell lymphoma.

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