Gastric, small bowel, and nodal lymphoma
Abdominal pain and bloating.
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Cardiophrenic adenopathy. Right pleural effusion.
Massive gastric thickening with areas of cavitation in the antrum.
Soft tissue thickening and cavitation of a small bowel loop in the right lower quadrant.
Retroperitoneal, mesenteric, pelvic, inguinal adenopathy.
Final Pathology: Mantle cell lymphoma
This case highlights gastric and small bowel involvement of lymphoma. The gastric infiltration and thickening is very dramatic. There is cavitation in the gastric antrum and small bowel due to infiltration of the muscular wall and myenteric plexus.
The extensive adenopathy surrounds and displaced vasculature, typical of lymphoma (e.g. lifting the aorta).
There are many potential biopsy targets. In this case, endoscopic biopsy was performed. However, ultrasound-guided percutaneous biopsy would be feasible in the right lower quadrant small bowel wall thickening, nodal masses, or gastric wall if needed.