Lymphoma - abdominal lymphadenopathy

Case contributed by Dr Dalia Ibrahim

Presentation

Vague abdominal pain.

Patient Data

Age: 40 years
Gender: Male

Multiple discrete pathologically enlarged abdominal lymph nodes were seen at the celiac, peripancreatic, splenic hilar, and para-aortic regions.

Splenomegaly showing tiny hypodense nodules.

Follow up PET-CT 1 year later

Nuclear medicine

Follow-up one year later without treatment showed FDG avid large amalgamated nodal mass infiltrating the pancreatic tail, splenic hilum, and the stomach, associated with multiple discreetly enlarged celiac and left para-aortic lymph nodes.

Biopsy of the splenic mass revealed mixed small and large cell lymphoma.

Case Discussion

Abdominal lymph nodes can be caused by inflammation or neoplastic processes. In this case, the patient initially presented with multiple discreetly enlarged abdominal lymph nodes and splenomegaly. Both lymphoma and granulomatous process were considered.

Histopathology was recommended, however, the patient refused the biopsy and was misdiagnosed by another institution as an inflammatory process. On follow-up, the case progressed into large amalgamated nodal masses infiltrating the splenic hilum, pancreatic tail, and stomach. Biopsy revealed mixed small and large cell lymphoma.

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