Non-Hodgkin's Lymphoma of the Appendix
Clinical and CT Findings with Pathologic Correlation
Perry J. Pickhardt1,2,
Angela D. Levy2,3,
Charles A. Rohrmann, Jr.3,4,
Susan L. Abbondanzo5 and
Amir I. Kende6
1 Department of Radiology, National Naval Medical Center, 8901 Wisconsin Ave.,
Bethesda, MD 20889-5600.
2 Department of Radiology and Nuclear Medicine, Uniformed Services University of
the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814.
3 Department of Radiologic Pathology, Armed Forces Institute of Pathology, 14th
St. and Alaska Ave., N.W., Washington, DC 20306-6000.
4 Present address: Department of Radiology (RR215), University of Washington,
1959 N.E. Pacific, Box 357115, Seattle, WA 98195-7115.
5 Department of Hematopathology, Armed Forces Institute of Pathology,
Washington, DC 20306-6000.
6 Department of Gastrointestinal Pathology, Armed Forces Institute of Pathology,
Washington, DC 20306-6000.
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Fig. 1A. —62-year-old man with remote history of non-Hodgkin's lymphoma
who presented with fever and chills. Axial images from unenhanced CT scan show
large tubular structure (arrowheads, A and B) extending
posteriorly into pelvis from cecal region. Note circumferential homogeneous
mural soft-tissue thickening and subtle but mildly prominent fluid-filled
lumen (arrow, A).
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Fig. 1B. —62-year-old man with remote history of non-Hodgkin's lymphoma
who presented with fever and chills. Axial images from unenhanced CT scan show
large tubular structure (arrowheads, A and B) extending
posteriorly into pelvis from cecal region. Note circumferential homogeneous
mural soft-tissue thickening and subtle but mildly prominent fluid-filled
lumen (arrow, A).
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Fig. 1C. —62-year-old man with remote history of non-Hodgkin's lymphoma
who presented with fever and chills. Lateral radiograph from barium
small-bowel examination shows smooth blind-ended collection of barium
(arrowheads) that corresponds to location and orientation of abnormal
appendix seen on A and B. Finding was also seen on image from
barium enema (not shown). Featureless aneurysmal appearance of lumen resembles
that of small-bowel lymphoma.
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Fig. 1D. —62-year-old man with remote history of non-Hodgkin's lymphoma
who presented with fever and chills. Photograph of gross pathologic specimen
shows massively enlarged appendix with slightly curved morphology that
correlates with appearance in A and B. Appendix appeared to be
torqued around its narrowed base. Diffuse lymphomatous replacement of
appendiceal wall was seen on microscopic examination (not shown). Luminal
diameter on cut section (not shown) was approximately 1 cm.
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Fig. 2A. —42-year-old man with AIDS who presented with fever,
leukocytosis, and acute right lower quadrant abdominal pain. Axial images from
contrast-enhanced CT scan show prominent blind-ended tubular structure
(arrowheads) representing enlarged appendix. Note hazy soft-tissue
stranding of periappendiceal fat.
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Fig. 2B. —42-year-old man with AIDS who presented with fever,
leukocytosis, and acute right lower quadrant abdominal pain. Axial images from
contrast-enhanced CT scan show prominent blind-ended tubular structure
(arrowheads) representing enlarged appendix. Note hazy soft-tissue
stranding of periappendiceal fat.
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Fig. 2C. —42-year-old man with AIDS who presented with fever,
leukocytosis, and acute right lower quadrant abdominal pain. Photograph of
cross-section through gross pathologic specimen shows diffuse replacement of
wall and obliteration of lumen by tannish tissue. Transmural extension of
lymphoma into periappendiceal fat was seen on microscopic examination (not
shown).
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Fig. 3A. —52-year-old man with no relevant medical history who
presented with fever and acute right lower quadrant abdominal pain. Axial
image from contrast-enhanced CT scan shows soft-tissue enlargement of appendix
(arrowheads) and stranding of periappendiceal fat.
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Fig. 3B. —52-year-old man with no relevant medical history who
presented with fever and acute right lower quadrant abdominal pain. Photograph
of gross pathologic specimen shows diffuse enlargement of appendix with
vermiform morphology maintained. On cut sections (not shown), proximal lumen
was obliterated, and focal perforation was identified near tip.
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Fig. 3C. —52-year-old man with no relevant medical history who
presented with fever and acute right lower quadrant abdominal pain.
Photomicrograph of histologic specimen shows diffuse mural thickening and
obliteration of lumen (arrow) due to infiltration by lymphoma. (H and
E, x10)
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Fig. 3D. —52-year-old man with no relevant medical history who
presented with fever and acute right lower quadrant abdominal pain.
Photomicrograph of histologic specimen shows monotonous lymphocytic
infiltration. Tumor was classified as diffuse large B-cell lymphoma. (H and E,
x400)
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Copyright © 2002 by the American Roentgen Ray Society.
