Gastric lymphoma

Case contributed by Dr Fakhry Mahmoud Ebouda

Presentation

An adult male complains of progressive weight loss, abdominal pain, nausea and repeated vomiting long time ago.

Patient Data

Age: 36 years.
Gender: Male
Modality: CT

An intraabdominal sizable soft tissue mass is seen intimately related to the pylorus. It shows trackling of contrast inside with variable hypodense areas of breaking down and cavitary formation. The gastroduodenal artery is seen traversing the mass. It measures 11.4 x 9.5x 9.6 cm in its AP, transverse and height respectively.

The mass has the following relations:

Superiorly it lies beneath the right lobe of the liver and near the GB and portahepatis.

Anteriorly it causes focal bulge of the anterior abdominal wall.

Posteriorly it displaces the IVC, SMV and portal veins.

Inferiorly: It causes large bowel (T. colon) displacement.

Laterally it displaces the surrounding bowel and pancreas.  Retro-aortic appearance of the left renal vein.

Modality: Photo

Exteme narrowing of the pylorus with surrounding soft tisseu buge (swelling) .

Modality: Pathology

Intraoperative images with gross macroscopic pathology for gastric lymphoma.

Modality: Pathology

Large B-cell non hodgkin gastric lymphoma, rich in histiocytes is proved after histopathology with immunohistochemical confirmation.

 

 

Case Discussion

The patient was submitted for CT that revealed large degenerated soft tissue mass is seen intimately related to the pylorus. The possibility of GIST Vs others was considered. Gastroscopy is then performed for the patient that showed severe mural wall thickening and narrowing of the pylorus. The patient underwent surgery that shows large mass than estimated by radiologic and laparoscopic procedures. Gastric lymphoma: large B-cell non hodgkin type, rich in histiocytes is proved after histopathology with immunohistochemical confirmation.

The case is courtesy of Dr/ Hani Fahmy , G.Surgery Consultant,

Thanks to Dr/ Mamdouh Radwan for Path. Photo.

Thanks to Dr/ Hani Afifi,  Gastroenterologist for Laproscopic photo.

 

 

 

 

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Case Information

rID: 27578
Case created: 8th Feb 2014
Last edited: 14th Sep 2016
Inclusion in quiz mode: Included

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