Lymphoma (hepatic and small bowel)
Abdominal pain. Lesions seen in liver and small bowel. Previous history of treated colorectal cancer and treated HCC.
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Partial resection of the left lobe of the liver is noted.
Lipiodol deposits superiorly in segment 8 and multiple liver cysts are unchanged.
Multiple hypodense liver lesions are present including in caudate 10 mm, segment 5 and segment 7.
There is a large centrally necrotic soft tissue mass anterior to the spleen.
Several abnormal bowel loops are demonstrated, with expansion by intraluminal masses/marked mural thickening, with no evidence of obstruction. These are demonstrated centrally, in the right iliac fossa and in the left side of the abdomen.
Previous large bowel surgery noted, with left colostomy.
No retroperitoneal or mesenteric lymph node enlargement.
Spleen, adrenals, and kidneys appear normal. Hyperdense mass in the left iliacus muscle.
Hypodense liver lesions are suspicious for metastases. Necrotic peritoneal metastasis anterior to the spleen. Multiple abnormal loops of small bowel, with mural thickening and expansion without obstruction, is suspicious for lymphoma.
Biopsy proven lymphoma.
The differentials to consider would be metastatic colon cancer, and even recurrent HCC to account for the hepatic lesions. The small bowel involvement however would be unusual for both of these, and more typical for lymphoma.