Presentation
General fatigue, weight loss and night sweats. Also has vague abdominal pain.
Patient Data
In the neck there are multiple prominent lymph nodes on both sides. The most prominent include right jugulodigastric measuring 19 x 13 mm and left supraclavicular measuring 15 x 16 mm. The palatine tonsils are prominent. The cervical soft tissues are otherwise unremarkable.
The lungs are clear apart from a 5 mm nodule in the right middle lobe. No pleural or pericardial effusion. Prominent lower para-aortic lymph nodes, the largest 15 x 24 mm. No other enlarged thoracic lymph nodes.
Extensive confluent nodal mass of the mesentery is demonstrated measuring up to 84 x 57 mm. There are also multiple other discrete mesenteric lymph nodes. In a segment of small bowel, likely distal jejunum or proximal ileum, there is aneurysmal dilatation and wall thickening, compatible with lymphoma.
The paraaortic nodes are enlarged and prominent, including nodes at the level of the renal hila measuring 20 mm in short axis. Mildly prominent inguinal nodes, the largest on the right measuring 10 mm short axis.
The liver and spleen are unremarkable, with no focal abnormality. The pancreas, adrenals, kidneys, stomach and colon are unremarkable.
No suspicious osseous lesions in the neck, chest, abdomen and pelvis.
Conclusion:
Conglomerate nodal mass in the mesentery with many other enlarged mesenteric, para-aortic and cervical lymph nodes is compatible with lymphoma. There is also a site of small bowel lymphoma in the distal jejunum / proximal ileum.
Case Discussion
The extensive nodal disease, both above and below the diaphragm, together with the conglomerate nodal masses in the abdomen is quite suggestive of lymphoma. Furthermore, the small bowel involvement is quite classic, with tumour causing "aneurysmal" dilatation of the lumen as opposed to narrowing as you would expect for the degree of soft tissue present.
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