Lymphoma of the terminal ileum

Case contributed by Matt A. Morgan


History of lymphoma. Denies abdominal pain, constipation, diarrhea, and change in bowel habits, but FDG-avidity in the terminal ileum on a recent PET-CT study.

Patient Data

Age: 55-60Y
Gender: Male

Images from a small bowel follow through.

In the terminal ileum, there is enlarged, confluent mucosal nodularity, compatible with a recurrence of lymphoma in the small bowel.

Annotated image

The first image is a zoomed-in image of the terminal ileum, showing large (>3 mm) confluent mucosal nodules, compatible with lymphoma.

In the second image, the red arrow points to the same findings in a different image.

Case Discussion

Mucosal nodularity in the small bowel has a limited differential.

If the nodules are small (1-3 mm) and discrete, nodular lymphoid hyperplasia should be considered.

If larger and more confluent, then lymphoma should be considered. Because of the predilection of both lymphoma and Crohn disease for the small bowel given the concentration of lymphoid tissue there, it is prudent to consider both diagnoses. The two have some overlapping features, but usually can be differentiated. Crohn disease usually has a different appearance, including ulceronodular changes and irregular fold thickening (as opposed to the smooth fold thickening of lymphoma). Also, although limited for differentiation between the two, Crohn disease tends to lead to strictures, whereas small bowel lymphoma may lead to a aneurysmally dilated small bowel.

In this case, the prior diagnosis of lymphoma and the activity on PET-CT leave the diagnosis in little doubt.

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