Non-Hodgkin lymphoma of the small bowel

Case contributed by Lukas Valkovic
Diagnosis almost certain

Presentation

Patient presented with abdominal pain, and sent for MRI exam to evaluate for suspected gynecological malignancy.

Patient Data

Age: 60
Gender: Female

There is a tubular thick-walled small bowel segment, i.e. circular tumorous infiltration of the small intestine wall. In this part of the bowel are signs of stagnation of intestinal content, but so far no bowel dilatation.

Other suspicious lymph nodes are just below the ventral abdominal wall in the left hypogastrium and also in the right obturator area. There is diffuse metastatic infiltration of the bone marrow.

CT demonstrates the extent of the mesenteric lymphadenopathy in addition to MRI findings.

Case Discussion

MRI findings suggested small intestine NHL with marked diffusion restriction in the affected area of small bowel. The diagnosis was confirmed histologically after surgical excision (the patient underwent surgery with resection of the affected part of small bowell, lymph node resection, hysterectomy, and oophorectomy). Atypical lymphatic tissue was also found in both ovaries (which can be retrospectively detected on DWI on the left side).

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