DOI:10.2214/AJR.07.3146
AJR 2008; 191:198-206
© American Roentgen Ray Society
Abdominal Manifestations of Extranodal Lymphoma: Spectrum of Imaging Findings
Wai-Kit Lee1,
Eddie W. F. Lau2,
Vinay A. Duddalwar3,
Anthony J. Stanley4 and
Yvonne Y. Ho4
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.
Received September 12, 2007;
accepted after revision January 27, 2008.
Address correspondence to W. K. Lee
(leewk33{at}hotmail.com).
CME
This article is available for CME credit. See
www.arrs.org
for more information.
Abstract
OBJECTIVE. The purpose of this article is to illustrate the spectrum
of appearances of extranodal lymphoma in the abdomen using cross-sectional
imaging techniques.
CONCLUSION. Extranodal lymphoma in the abdomen can mimic other
neoplastic or inflammatory conditions. Although a definitive diagnosis is
possible only with biopsy, it is important to consider extranodal lymphoma in
the presence of certain imaging appearances in the appropriate clinical
setting for the correct diagnosis, accurate staging, and optimal
management.
Keywords: abdomen • CT • extranodal lymphoma • PET/CT • sonography
Introduction
Extranodal lymphoma occurs in about 40% of patients with lymphoma and has
been de scribed in virtually every organ and tissue
[1]. In decreasing order of
frequency, the spleen, liver, gastrointestinal tract, pancreas, abdominal
wall, genitourinary tract, adrenal, peritoneal cavity, and biliary tract are
involved
[2–5].
Extranodal disease is more common with non-Hodgkin's lymphoma (NHL) than with
Hodgkin's lymphoma and is often intermediate- to high-grade
[2,
3]. AIDS-related lymphoma and
post trans plantation lymphoproliferative dis order (PTLD) are more likely to
affect extra nodal sites and are of higher grade
[2,
4,
5]. Diffuse large B-cell
lymphoma and follicular lymphoma are the dominant histologic sub types in
extranodal lymphoma. Mantle cell lymphoma, lympho blastic lymphoma, Burkitt's
lymphoma, and mucosa-associated lymphoid tissue (MALT) lymphoma, however, are
more likely to affect extranodal sites
[2]. MALT lymphoma is a
low-grade marginal zone B-cell lymphoma that is most commonly found in the
stomach. It is closely associated with chronic inflammation, such as
Helicobacter pylori gastritis, and has a clinically indolent course.
Secondary involve ment of extranodal tissues as part of generalized lymphoma
is signi ficantly more common than primary extra nodal disease, in which there
is a dominant extranodal component with no or minor nodal involvement.
Splenic, hepatic, or diffuse involvement of one or more extranodal organs
indicates a more advanced stage of disease. Extranodal involvement is in
general a poor prognostic factor.
The protean imaging appearances of extranodal lymphoma in the abdomen can
mimic other neoplastic or inflammatory condi tions. Misinterpretation of the
imaging findings can lead to delayed diagnosis and treatment, and incorrect
staging may result in inappropriate treatment. In this article, we illustrate
the appearances of extranodal lymphoma in the abdomen of immuno competent and
immunocompromised patients with current cross-sectional im aging
techniques.
Imaging Techniques
MDCT is the principal imaging technique used for the evaluation of patients
with lymphoma. However, evidence indicates that PET/CT is superior to CT in
detecting extranodal disease in the abdomen, especially in the spleen and
liver [1,
6]. The role of PET/CT in
low-grade lymphoma such as MALT lymphoma is controversial. For the routine
evaluation of abdominal lymphoma, no data are available at present on the
effectiveness of MRI, and sonography has no role. Patients unsuitable for CT
can be assessed with MRI. Sonography and MRI can be used for targeted
characterization of indeterminate lesions identified at CT.
At our institution, routine abdominopelvic CT for the evaluation of
lymphoma is usually performed after the patient has drunk 900 mL of 2.5%
diluted sodium amidotrizoate and meglumine amidotrizoate (Gastrografin, Bayer
HealthCare) 45–60 minutes before the examination. One hundred
milliliters of 370 mg I/mL of iopromide (Ultravist 370, Bayer HealthCare) is
administered IV at a rate of 2.5 mL/s. CT is performed after a 75-second
delay. For 16- and 64-MDCT scanners, 0.75- and 0.6- mm detectors are used,
respectively, with 120 kVp and 150–180 mAs. In suspected gastric or
enteric involvement, CT is performed after the patient has drunk
1,000–1,500 mL of water or 2% sorbitol. In suspected colonic
involvement, CT is performed after the administration of 500–1,000 mL of
water or 2.5% di luted sodium amidotrizoate and meglumine amido trizoate
(Gastrografin) as rectal contrast medium.
Routine PET/CT for the evaluation of lymphoma is performed after an IV
injection of 370 MBq of 18F-FDG that is administered 45–60
minutes before the scan. A low-dose CT acquisition is first performed (120
kVp, average of 64 mAs) from the skull base to the mid thigh, without IV or
oral contrast material and no specific breath-holding instructions. A PET
emission scan is immediately performed after the CT acquisition over the same
range as CT, without changing the patient's position. Images are reconstructed
with a 16-subset, two-iteration algorithm, 256 x 256 matrix, and a
CT-based attenuation coefficient. In suspected gastric or enteric involvement,
the study is performed after the patient has ingested 1,000–1,500 mL of
water or 2% sorbitol. If colonic involvement is suspected, the study is
performed after the administration of 500–1,000 mL of water as a rectal
contrast medium. In suspected urinary tract involve ment, the study is per
formed after IV hydration with 0.9% saline, an IV bolus of 20 mg of frusemide,
and insertion of a urinary catheter.
At our institution, abdominopelvic MRI evaluation for lymphoma is performed
with a torso phased-array coil. The protocol consists of axial 2D T1- and
T2-weighted fast spin-echo sequences; a coronal, fat-suppressed T2-weighted
short tau inversion recovery sequence; and coronal breath-hold fat-sup pressed
dynamic 3D T1-weighted gradient-echo sequences before and after the IV
administration of gadolinium. In suspected gastric or enteric involvement, the
study is performed after the patient has drunk 1,000–1,500 mL of water
or 2% sorbitol. In suspected colonic involvement, the study is performed after
the administration of 500–1,000 mL of water as a rectal contrast medium.
An IV bolus of 20 mg of N-butyl scopolamine is administered when
enteric or colonic disease is suspected.
Liver and Spleen
The spleen and liver are involved in 20–40% and up to 15% of patients
with lymphoma, respectively
[1–3].
The patterns of involvement include diffuse infiltration
(Fig. 1), with or without
organomegaly, and focal nodules (Fig.
2A,
2B). FDG PET/CT is more
accurate than other cross-sectional tech niques for the detection of diffuse
hepato splenic involvement [6].
Focal hepatosplenic lym phoma appears as cir cum scribed nodules that are
hypoechoic, show no posterior acoustic enhancement on sono graphy, and are
low-attenuation on contrast-enhanced CT. On MRI, the nodules may appear as
hypo- or iso intense compared with normal spleen or liver on T1-weighted
images and as hyper intense on T2-weighted images, and may show reduced
enhancement after the admin istration of gadolinium. Focal hepato splenic lym
pho mas can be in dis tin guishable from meta stases but are usually smaller
and homo geneous and occur with extensive, bulky coalescent lymph nodes.
Hepatosplenic fungal abscesses tend to be smaller and show hetero geneous
enhance ment compared with lymphoma.
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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.
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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).
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Gastrointestinal Tract
Extranodal lymphoma in the gastrointestinal tract occurs in 10–30% of
all patients with NHL [2,
7]. The stomach, small bowel,
pharynx, large bowel, and esophagus are involved in decreasing order of
frequency [7]. The patterns of
gastric involvement include polypoidal mass, diffuse or focal infiltration
(Fig. 3A,
3B), ulcerative lesion, or
mucosal nodularity [8]. The
patterns of small-bowel involvement include solitary or multiple nod ules
(Fig. 4), circumferential wall
thick ening with or without aneurysmal dilatation (Figs.
4 and
5), and direct extension from
mesenteric nodes [7,
9]. The cecum and rectum are
the most commonly involved parts of the large bowel. The patterns of
large-bowel involvement include bulky poly poidal mass, infiltrative tumor
(Fig. 6), and aneurysmal
dilatation [7]. Bowel per
foration is an un com mon complication of gastro intestinal lympho ma but is
more likely with T-cell lymphoma, with PTLD, and after chemo therapy or
radiation therapy [5,
7–9].
Bowel obstruction is uncom mon at present ation despite significant lym
phomatous in filtration of the bowel wall because of absent desmoplastic
reaction [7,
9]. In contrast to
gastrointestinal adenocarcin oma, lymphoma is more likely to involve multiple
and longer segments of gut and is less likely to cause bowel obstruction
[8].
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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).
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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).
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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.
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Genitourinary Tract
Renal involvement occurs in 3–8% of patients with lymphoma; the
kidney is the most commonly involved part of the genito urinary tract
[10]. The patterns of renal
involvement, in descending order of frequency, include multiple circumscribed
masses (Figs. 7A,
7B and
8), direct infiltration from
adjacent nodes, a solitary mass, an isolated perinephric mass
(Fig. 9), and diffuse
infiltration [10]
(Fig. 10). Renal metastases
can mimic renal lym pho ma. Renal cell carcinomas can often be differentiated
from renal lymphoma by their hypervascular enhancement pattern. Trans itional
cell carcinoma and severe pyelonephritis may mimic diffuse renal in filtration
by lym pho ma. Exten sive bulky coalescent lymph nodes and absence of features
of an infective process are supportive of the dia gnosis of lym pho ma.
Predominant peri pelvic or renal sinus involvement by lym pho ma is uncommon
[10,
11].
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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.
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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).
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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).
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Despite peripelvic lymphoma encasing renal hilar structures, the vessels
often remain patent, and there is often minimal hydronephrosis (Fig.
11A,
11B,
11C,
11D,
11E). This helps to
differentiate peripelvic lymphoma from transitional cell carcinoma or
metastases. The ureter is often affected by involved retroperitoneal nodes,
but primary involvement of the ureter by lymphoma is rare
[12]. About 8% of patients
with lymphoma have bladder involvement at autopsy
[10,
13]. The patterns of bladder
involvement include circumscribed solitary or multiple masses (Fig.
12A,
12B) and diffuse infiltration
[13]. Transitional cell
carcinoma may mimic bladder lymphoma. Approximately 6% of patients with
lymphoma have testicular involvement at autopsy
[10]. Lympho ma is the most
common testicular tumor in older men; bilateral involvement occurs in 38% of
cases [1]. The patterns of
testicular involvement include focal masses
(Fig. 13) and diffuse
infiltration with or without testicular enlargement
[2].
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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).
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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.
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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.
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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.
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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).
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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.
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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.
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Pancreas
The pancreas is involved in about 30% of cases of NHL, usually from
contiguous nodal infiltration
[14]. The patterns of
involvement include a circumscribed mass (Figs.
14 and
15) and diffuse glandular
enlargement mimicking acute pancreatitis
[14]. Although bile duct
obstruction may occur with pancreatic lymphoma, moderate to severe dilatation
of the main pancreatic duct despite a bulky tumor is uncommon. Vascular
invasion, pancreatic atrophy distal to the tumor, and tumor calcification and
necrosis are unusual at initial presentation
[14]. These features can help
to differentiate pancreatic lymphoma from adenocarcinoma.
Adrenal Gland
The adrenal gland is involved in about 4% of cases of NHL
[1,
15]. Bilateral adrenal involve
ment occurs in approximately 50% of these cases. The patterns of involvement
include a rounded circumscribed homo geneous mass
(Fig. 16) and an enlarged
adrenal gland that main tains its normal shape
[15].
Biliary Tract
Lymphomatous involvement of the biliary tree is rare. The patterns of
involvement of the gallbladder include an intraluminal polypoidal mass, a
large mass replacing the gallbladder, and diffuse mural thickening
[16] (Fig.
17A,
17B). The patterns of
involvement of the bile ducts include a biliary stricture mimicking chol angio
carcinoma and a focal mass
[17].
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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).
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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.
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Peritoneum and Peritoneal Reflections
Peritoneal lymphomatosis is a rare clinical presentation that is often
associated with high-grade primary gastrointestinal NHL and is radiologically
indistinguishable from peri toneal carcinomatosis
[18]. The patterns of
involvement include discrete nodules, a diffuse infiltrative mass, and ascites
(Fig. 18A,
18B). Exudative ascites from
peritoneal lympho matosis shows high attenuation because of the increased
proteinaceous content [18].
Loc u lat ed high-attenuation ascites and smooth peritoneal enhancement are
more char ac ter istic of tuberculous peritonitis. Diffuse lym pho matous in
filtration of the mesentery produces a stellate appearance of the mesen tery
and causes fixation of the small-bowel loops (Fig.
18A,
18B).
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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.
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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.
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Abdominal Wall
Lymphoma may involve the abdominal wall by direct extension from bone or
may occur separately in the muscle, subcutaneous fat, or skin from
hematogenous spread (Fig. 19A,
19B).
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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.
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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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Conclusion
The wide spectrum of imaging appearances of extranodal lymphoma in the
abdomen presented in this article should serve to alert the radiologist to
consider its diagnosis in patients with or without a history of lymph oma in
the presence of supportive collective imaging findings and suggestive clinical
features. Although a definitive diagnosis of extranodal lymphoma is possible
only with biopsy, certain findings (e.g., a bulky tumor of the
gastrointestinal tract involving multiple segments with aneurysmal dilatation
or without bowel obstruction; a bulky, homogeneous, noncalcified pancreatic
mass with out significant dilatation of the main pan creatic duct; or a
peripelvic renal mass without significant hydronephrosis) together with
extensive bulky coalescent lymph nodes and absent features of an infective
process are strongly suggestive of the diagnosis.
References
- Metser U, Goor O, Lerman H, Naparstek E, Even-Sapir E. PET-CT of
extranodal lymphoma. AJR 2004;182
:1579
–1586[Free Full Text]
- Vinnicombe SJ, Reznek RH. Extranodal manifestations of lymphoma.
Imaging 1999; 11:240
–268[Abstract]
- Guermazi A, Brice P, de Kerviler E, et al. Extranodal Hodgkin
disease: spectrum of disease. RadioGraphics2001; 21:161
–179[Abstract/Free Full Text]
- Nyberg DA, Jeffrey RB, Federle MP, Bottles K, Abrams DI.
AIDS-related lymphomas: evaluation by abdominal CT.
Radiology 1986;159
: 59–63[Abstract/Free Full Text]
- Dodd GD, Greenler DP, Confer SR. Thoracic and abdominal
manifestations of lymphoma occurring in the immunocompromised patient.
Radiol Clin North Am 1992;30
: 597–610[Medline]
- Rini JN, Leonidas JC, Tomas MB, Palestro CJ. 18F-FDG PET
versus CT for evaluating the spleen during initial staging of lymphoma.
J Nucl Med 2003;44
:1072
–1074[Abstract/Free Full Text]
- Levine MS, Rubesin SE, Pantongrag-Brown L, Buck JL, Herlinger H.
Non-Hodgkin's lymphoma of the gastrointestinal tract: radiographic findings.
AJR 1997; 168:165
–172[Free Full Text]
- Ghai S, Pattison J, Ghai S, O'Malley ME, Khalili K, Stephens M.
Primary gastrointestinal lymphoma: spectrum of imaging findings with
pathologic correlation. RadioGraphics2007; 27:1371
–1388[Abstract/Free Full Text]
- Balthazar EJ, Noordhoorn M, Megibow AJ, Gordon RB. CT of
small-bowel lymphoma in immuno competent patients and patients with AIDS:
comparison of findings. AJR 1997;168
: 675–680[Abstract/Free Full Text]
- Sheth S, Ali S, Fishman E. Imaging of renal lymphoma: patterns of
disease with pathologic correlation. RadioGraphics2006; 26:1151
–1168[Abstract/Free Full Text]
- McMillin KI, Gross BH. CT demonstration of peripelvic and
periureteral non-Hodgkin lymphoma. AJR1985; 144:945
–946[Free Full Text]
- Atkinson DS, Chaoui AS, Fenlon HM, Barish MA. Lymphomatous
infiltration of the right ureter. AJR1999; 173:789[Medline]
- Bates AW, Norton AJ, Baithun SI. Malignant lymphoma of the urinary
bladder: a clinico pathological study of 11 cases. J Clin
Pathol 2000; 53:458
–461[Abstract/Free Full Text]
- Merkle EM, Bender GN, Brambs H. Imaging findings in pancreatic
lymphoma: differential aspects. AJR 2000;174
: 671–675[Free Full Text]
- Paling MR, Williamson BR. Adrenal involvement in non-Hodgkin
lymphoma. AJR 1983;141
: 303–305[Abstract/Free Full Text]
- Kim MJ, Kim KW, Kim HC, et al. Unusual malignant tumors of the
gallbladder. AJR 2006;187
: 473–480[Abstract/Free Full Text]
- Das K, Fisher A, Wilson DJ, dela Torre AN, Seguel J, Koneru B.
Primary non-Hodgkin's lymphoma of the bile ducts mimicking cholangiocarcinoma.
Surgery 2003; 134:496
–500[CrossRef][Medline]
- Lynch MA, Cho KC, Jeffrey RB, Alterman DD, Federle MP. CT of
peritoneal lymphomatosis. AJR 1988;151
: 713–715[Abstract/Free Full Text]
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Abstract
Introduction
