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Abdominal Manifestations of Extranodal Lymphoma: Spectrum of Imaging Findings

¹ Department of Medical Imaging, St. Vincent's Hospital, University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia.
² Department of Radiology, Centre for Molecular Imaging, Peter MacCallum Cancer Centre, University of Melbourne, East Melbourne, Victoria 3002, Australia.
³ Department of Radiology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
⁴ Department of Diagnostic Imaging, The National University Hospital of Singapore, National University of Singapore, Singapore.

View larger version (97K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —52-year-old woman with large B-cell lymphoma involving spleen. Axial fused PET/CT image shows diffuse increased 18F-FDG uptake in normal-sized spleen (arrow), indicating splenic involvement.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —74-year-old woman with biopsy-proven large B-cell lymphoma involving liver and spleen. Longitudinal sonogram of right lobe of liver shows multiple hypoechoic nodules (arrowheads).

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —74-year-old woman with biopsy-proven large B-cell lymphoma involving liver and spleen. Axial contrast-enhanced CT image shows multiple circumscribed low-attenuation nodules in liver and spleen (arrowheads).

View larger version (139K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —62-year-old man with biopsy-proven large B-cell lymphoma involving stomach. Axial contrast-enhanced CT image shows focally infiltrative tumor involving body of stomach (arrow).

View larger version (96K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —62-year-old man with biopsy-proven large B-cell lymphoma involving stomach. Corresponding axial fused PET/CT image shows 18F-FDG-avid tumor (arrow).

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —52-year-old man with mantle cell lymphoma involving small bowel. Coronal contrast-enhanced CT image shows nodular masses in proximal small bowel (arrowheads) and marked mural thickening of distal ileum (large arrow). Note mesenteric nodes (M) and right inguinal node (small arrow).

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5 —62-year-old man with follicular lymphoma of small bowel. Axial contrast-enhanced CT image shows circumferential thickening and aneurysmal dilatation of segment of distal ileum (arrows).

View larger version (166K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6 —73-year-old man with biopsy-proven large B-cell lymphoma involving small and large bowel. Coronal contrast-enhanced CT image shows bulky infiltrative tumor (arrows) involving distal ileum (I), cecum (C), and ascending colon (A). No small-bowel dilatation is seen proximal to tumor.

View larger version (123K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —37-year-old man with T-cell lymphoblastic lymphoma involving kidneys. Axial contrast-enhanced CT image shows multiple bilateral, circumscribed low-attenuation renal masses.

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —37-year-old man with T-cell lymphoblastic lymphoma involving kidneys. Longitudinal sonogram of right kidney shows multiple hypoechoic masses (arrowheads). Similar hypoechoic masses were seen in left kidney (not shown). These lymphomatous deposits resolved after chemotherapy.

View larger version (109K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8 —63-year-old woman with newly diagnosed large B-cell lymphoma involving kidneys. Axial fused PET/CT image shows bilateral 18F-FDG-avid renal lymphomatous deposits (arrows).

View larger version (122K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9 —60-year-old man with biopsy-proven perinephric mucosa-associated lymphoid tissue lymphoma. Coronal contrast-enhanced CT image shows soft-tissue perinephric mass that partially encases lower left kidney without frank renal invasion (arrowheads).

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10 —61-year-old woman with biopsy-proven large B-cell lymphoma involving kidney. Coronal contrast-enhanced CT image shows left renomegaly and complete replacement of kidney by lymphoma (arrowheads).

View larger version (189K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11A —73-year-old man with biopsy-proven peripelvic follicular lymphoma of kidney. Axial contrast-enhanced prone CT image shows soft-tissue mass encasing left renal hilum (arrow). Left renal hilar vessels are patent. No hydronephrosis is seen. Note calyceal diverticulum with dependent calculi (arrowhead).

View larger version (162K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11B —73-year-old man with biopsy-proven peripelvic follicular lymphoma of kidney. Axial fat-suppressed T2-weighted fast spin-echo (B), axial T1-weighted fast spin-echo (C), and axial gadolinium-enhanced fat-suppressed T1-weighted fast spin-echo (D) images show T2 hyperintense and T1 hypointense mass that mildly enhances with IV gadolinium (arrow). Arrowheads indicate calyceal diverticulum with dependent calculi.

View larger version (173K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11C —73-year-old man with biopsy-proven peripelvic follicular lymphoma of kidney. Axial fat-suppressed T2-weighted fast spin-echo (B), axial T1-weighted fast spin-echo (C), and axial gadolinium-enhanced fat-suppressed T1-weighted fast spin-echo (D) images show T2 hyperintense and T1 hypointense mass that mildly enhances with IV gadolinium (arrow). Arrowheads indicate calyceal diverticulum with dependent calculi.

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11D —73-year-old man with biopsy-proven peripelvic follicular lymphoma of kidney. Axial fat-suppressed T2-weighted fast spin-echo (B), axial T1-weighted fast spin-echo (C), and axial gadolinium-enhanced fat-suppressed T1-weighted fast spin-echo (D) images show T2 hyperintense and T1 hypointense mass that mildly enhances with IV gadolinium (arrow). Arrowheads indicate calyceal diverticulum with dependent calculi.

View larger version (133K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11E —73-year-old man with biopsy-proven peripelvic follicular lymphoma of kidney. Axial fused PET/CT image shows 18F-FDG-avid tumor (arrow).

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12A —55-year-old woman with biopsy-proven mucosa-associated lymphoid tissue lymphoma involving bladder. Axial contrast-enhanced CT image shows polypoid soft-tissue mass arising from right lateral wall of bladder (arrow).

View larger version (88K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12B —55-year-old woman with biopsy-proven mucosa-associated lymphoid tissue lymphoma involving bladder. Corresponding axial fused PET/CT image shows moderate 18F-FDG activity in tumor (arrow) compared with "hot" urine.

View larger version (146K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13 —70-year-old man with histologically proven large B-cell lymphoma involving testes. Longitudinal sonogram shows large, hypoechoic, circumscribed mass in left testis (arrowheads). Multiple smaller but similar masses were seen in right testis (not shown). Histopathology of resected left testis revealed large B-cell lymphoma.

View larger version (156K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 14 —59-year-old man with large B-cell lymphoma involving pancreas. Axial contrast-enhanced CT image shows two low-attenuation tumor nodules in pancreatic body (arrowheads).

View larger version (108K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 15 —72-year-old woman with large B-cell lymphoma involving pancreas. Axial fused PET/CT image shows 18F-FDG-avid pancreatic body lymphomatous deposit (arrowhead).

View larger version (112K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 16 —55-year-old woman with large B-cell lymphoma involving adrenals. Axial contrast-enhanced CT image shows rounded large bilateral adrenal tumors (arrows).

View larger version (100K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 17A —61-year-old woman with histologically proven primary mucosa-associated lymphoid tissue lymphoma in gallbladder. Longitudinal sonogram shows diffuse, asymmetric mural thickening of gallbladder (arrowheads).

View larger version (181K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 17B —61-year-old woman with histologically proven primary mucosa-associated lymphoid tissue lymphoma in gallbladder. Axial contrast-enhanced CT image shows homogeneous soft-tissue thickening of wall of gallbladder (arrowheads) without tumoral invasion of adjacent liver.

View larger version (141K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 18A —57-year-old woman with peritoneal lymphomatosis. (Courtesy of Henderson R, Los Angeles, CA) Axial unenhanced CT image shows ascites that is similar in attenuation to adjacent muscle. Linear bands of soft-tissue attenuation run through mesenteric fat, indicating tumor infiltration (arrowheads) that causes tethering of small bowel.

View larger version (118K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 18B —57-year-old woman with peritoneal lymphomatosis. (Courtesy of Henderson R, Los Angeles, CA) Corresponding axial fused PET/CT image shows ascites and mesenteric tumor that are intensely 18F-FDG-avid.

View larger version (102K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 19A —54-year-old man with diffuse large B-cell lymphoma involving retroperitoneum, abdominal wall, and lumbar spine. Axial T2-weighted fast spin-echo image shows large right-sided retroperitoneal mass (arrows) that infiltrates paravertebral muscle (M), causes adjacent L1 vertebral destruction (arrowhead), and extends into epidural space to displace cauda equina. Right kidney (K) is anteriorly displaced.

View larger version (84K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 19B —54-year-old man with diffuse large B-cell lymphoma involving retroperitoneum, abdominal wall, and lumbar spine. Axial fused PET/CT image at L3–L4 disk level 1 year after initial treatment shows multiple new 18F-FDG-avid subcutaneous tumor nodules (arrowheads).

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