Lymphoma

Case contributed by Dr Craig Hacking

Presentation

Staging CT for sigmoid cancer.

Patient Data

Age: 57
Gender: Female
CT

Chest

Bilateral mastectomies and axillary clearance clips noted. No residual anterior chest wall mass lesion. Peri-aortic posterior mediastinal soft tissue surrounding more than half of the circumference of the descending aorta below the level of the carina. Axially this measures 32 x 13 mm maximally. This is similar density but not contiguous with nodular thickening of the right vertebral and posterior costal pleura, measuring 14 mm in maximum thickness. No mediastinal lymphadenopathy elsewhere. No supraclavicular or hilar lymphadenopathy.

The lungs are clear apart from minor plate atelectasis in the anterior middle lobe and a small peri-fissural lymph node in the horizontal fissure. No pleural effusion.

Extensive coronary artery calcification. No evidence of bony metastasis.

Abdomen and pelvis

Large amount of soft tissue within the small bowel mesentery and retroperitoneum surrounding multiple vessels, transversely measuring up to 100 mm in the mesentery and 80 mm in the retroperitoneum. There is thickening of Gerota's fascia bilaterally. There is no arterial narrowing evident in the mesentery, however the renal arteries and the left renal vein are compressed by the periaortic retroperitoneal soft tissue. There is however no delayed nephrogram on the left to suggest renovascular compromise. The retroperitoneal disease causes medial deviation of the right ureter, but the ureter is non-dilated. No duodenal compression or small bowel dilatation evident.

Within the mesentery, there are multiple enhancing lymph nodes which do not appear particularly enlarged. Retrocrural lymphadenopathy measures 22 mm. Two small greater omental lymph nodes are noted, not enlarged by CT size criteria.

No evidence of solid organ metastasis. Multiple simple exophytic cysts on the right kidney. No sigmoid colon lesion identified.

Incidental fat containing umbilical hernia. Multiple small subcutaneous soft tissue density foci in the anterior abdominal wall likely represent sites of recent hypodermic injection rather than subcutaneous metastatic deposits. No evidence of bony metastasis.

Conclusion

Extensive posterior mediastinal, right pleural, mesenteric and retroperitoneal soft tissue disease, representing lymphoid tissue. This is highly suspicious of lymphoma. It would be extremely rare for this to be due to metastatic bowel or breast malignancy.

Case Discussion

Further Hx Past history of breast cancer.

Histology = B cell lymphoma

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Case information

rID: 36809
Case created: 12th May 2015
Last edited: 21st Oct 2015
Inclusion in quiz mode: Included

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