DOI QR코드

DOI QR Code

Typical and Atypical Imaging Features of Malignant Lymphoma in the Abdomen and Mimicking Diseases

복부 악성 림프종의 영상 소견 및 비슷한 소견을 보일 수 있는 질병들

  • Jong Eun Kim (Department of Radiology, Gil Medical Center, Gachon University College of Medicine) ;
  • So Hyun Park (Department of Radiology, Gil Medical Center, Gachon University College of Medicine) ;
  • Young Sup Shim (Department of Radiology, Gil Medical Center, Gachon University College of Medicine) ;
  • Sungjin Yoon (Department of Radiology, Gil Medical Center, Gachon University College of Medicine)
  • 김종은 (가천대학교 의과대학 길병원 영상의학과) ;
  • 박소현 (가천대학교 의과대학 길병원 영상의학과) ;
  • 심영섭 (가천대학교 의과대학 길병원 영상의학과) ;
  • 윤성진 (가천대학교 의과대학 길병원 영상의학과)
  • Received : 2023.02.07
  • Accepted : 2023.05.06
  • Published : 2023.11.01

Abstract

Malignant lymphoma typically presents with homogeneous enhancement of enlarged lymph nodes without internal necrotic or cystic changes on multiphasic CT, which can be suspected without invasive diagnostic methods. However, some subtypes of malignant lymphoma show atypical imaging features, which makes diagnosis challenging for radiologists. Moreover, there are several lymphoma-mimicking diseases in current clinical practice, including leukemia, viral infections in immunocompromised patients, and primary or metastatic cancer. The ability of diagnostic processes to distinguish malignant lymphoma from mimicking diseases is necessary to establish effective management strategies for initial radiological examinations. Therefore, this study aimed to discuss the typical and atypical imaging features of malignant lymphoma as well as mimicking diseases and discuss important diagnostic clues that can help narrow down the differential diagnosis.

악성 림프종은 역동적 조영증강 컴퓨터단층촬영에서 전형적으로 커진 림프절 이 균일한 조영증강을 보이며 내부에 괴사 및 낭성 병변을 보이지 않는 영상 소견을 보이며, 이를 통해 침습적인 진단 검사 없이도 의심할 수 있다. 그러나 일부 림프종은 비전형적인 영상 소견을 보여 영상의학과 의사가 진단하는데 어려움을 겪는다. 더욱이, 실제 임상 현장에서는 백혈병, 면역저하자의 바이러스 감염, 원발암 및 전이암들이 림프종과 유사하게 보여 감별진단하는데 어려움이 있다. 초기에 영상검사로 악성 림프종과 이러한 유사질환을 구별하는것은 적절한 치료방침을 결정하는데 중요하다. 따라서, 본 임상 화보의 목표는 림프종의 전형적, 비전형적 영상 소견과 림프종을 모방하는 병변들의 영상 소견을 보여주며, 감별 진단을 좁히는데 도움이 되는 중요한 소견들을 논의하고자 한다.

Keywords

References

  1. Jamil A, Mukkamalla SKR. Lymphoma. Available at. https://www.ncbi.nlm.nih.gov/books/NBK560826/?report=printable. Published 2021. Accessed January 15, 2023
  2. Alaggio R, Amador C, Anagnostopoulos I, Attygalle AD, Araujo IBO, Berti E, et al. The 5th edition of the World Health Organization classification of haematolymphoid tumours: lymphoid neoplasms. Leukemia 2022;36:1720-1748 https://doi.org/10.1038/s41375-022-01620-2
  3. Frampas E. Lymphomas: basic points that radiologists should know. Diagn Interv Imaging 2013;94:131-144 https://doi.org/10.1016/j.diii.2012.11.006
  4. Johnson SA, Kumar A, Matasar MJ, Schoder H, Rademaker J. Imaging for staging and response assessment in lymphoma. Radiology 2015;276:323-338 https://doi.org/10.1148/radiol.2015142088
  5. Krol AD, le Cessie S, Snijder S, Kluin-Nelemans JC, Kluin PM, Noordijk EM. Primary extranodal non-Hodgkin's lymphoma (NHL): the impact of alternative definitions tested in the Comprehensive Cancer Centre West population-based NHL registry. Ann Oncol 2003;14:131-139 https://doi.org/10.1093/annonc/mdg004
  6. Cheson BD, Fisher RI, Barrington SF, Cavalli F, Schwartz LH, Zucca E, et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol 2014;32:3059-3068 https://doi.org/10.1200/JCO.2013.54.8800
  7. Jiang H, Li A, Ji Z, Tian M, Zhang H. Role of radiomics-based baseline PET/CT imaging in lymphoma: diagnosis, prognosis, and response assessment. Mol Imaging Biol 2022;24:537-549 https://doi.org/10.1007/s11307-022-01703-7
  8. Li J, Wang J, Yang Z, Wang H, Che J, Xu W. Castleman disease versus lymphoma in neck lymph nodes: a comparative study using contrast-enhanced CT. Cancer Imaging 2018;18:28
  9. Chae SY, Jung HN, Ryoo I, Suh S. Differentiating cervical metastatic lymphadenopathy and lymphoma by shear wave elastography. Sci Rep 2019;9:12396
  10. Ferrer R. Lymphadenopathy: differential diagnosis and evaluation. Am Fam Physician 1998;58:1313-1320
  11. Gaddey HL, Riegel AM. Unexplained lymphadenopathy: evaluation and differential diagnosis. Am Fam Physician 2016;94:896-903
  12. Manzella A, Borba-Filho P, D'Ippolito G, Farias M. Abdominal manifestations of lymphoma: spectrum of imaging features. ISRN Radiol 2013;2013:483069
  13. Hardy SM. The sandwich sign. Radiology 2003;226:651-652 https://doi.org/10.1148/radiol.2263020109
  14. Medappil N, Reghukumar R. Sandwich sign in mesenteric lymphoma. J Cancer Res Ther 2010;6:403-404 https://doi.org/10.4103/0973-1482.73333
  15. Wang HW, Balakrishna JP, Pittaluga S, Jaffe ES. Diagnosis of Hodgkin lymphoma in the modern era. Br J Haematol 2019;184:45-59 https://doi.org/10.1111/bjh.15614
  16. Adams HJA, de Klerk JMH, Fijnheer R, Dubois SV, Nievelstein RAJ, Kwee TC. Prognostic value of tumor necrosis at CT in diffuse large B-cell lymphoma. Eur J Radiol 2015;84:372-377 https://doi.org/10.1016/j.ejrad.2014.12.009
  17. Hopper KD, Diehl LF, Cole BA, Lynch JC, Meilstrup JW, McCauslin MA. The significance of necrotic mediastinal lymph nodes on CT in patients with newly diagnosed Hodgkin disease. AJR Am J Roentgenol 1990;155:267-270 https://doi.org/10.2214/ajr.155.2.2115249
  18. Saito A, Takashima S, Takayama F, Kawakami S, Momose M, Matsushita T. Spontaneous extensive necrosis in non-Hodgkin lymphoma: prevalence and clinical significance. J Comput Assist Tomogr 2001;25:482-486 https://doi.org/10.1097/00004728-200105000-00024
  19. Thomas AG, Vaidhyanath R, Kirke R, Rajesh A. Extranodal lymphoma from head to toe: part 2, the trunk and extremities. AJR Am J Roentgenol 2011;197:357-364 https://doi.org/10.2214/AJR.11.6738
  20. Olszewska-Szopa M, Wrobel T. Gastrointestinal non-Hodgkin lymphomas. Adv Clin Exp Med 2019;28:1119-1124 https://doi.org/10.17219/acem/94068
  21. Lo Re G, Federica V, Midiri F, Picone D, La Tona G, Galia M, et al. Radiological features of gastrointestinal lymphoma. Gastroenterol Res Pract 2016;2016:2498143
  22. Ghai S, Pattison J, Ghai S, O'Malley ME, Khalili K, Stephens M. Primary gastrointestinal lymphoma: spectrum of imaging findings with pathologic correlation. Radiographics 2007;27:1371-1388 https://doi.org/10.1148/rg.275065151
  23. Ciftci AO, Tanyel FC, Kotiloglu E, Hicsonmez A. Gastric lymphoma causing gastric outlet obstruction. J Pediatr Surg 1996;31:1424-1426 https://doi.org/10.1016/S0022-3468(96)90845-3
  24. Levine MS, Rubesin SE, Pantongrag-Brown L, Buck JL, Herlinger H. Non-Hodgkin's lymphoma of the gastrointestinal tract: radiographic findings. AJR Am J Roentgenol 1997;168:165-172 https://doi.org/10.2214/ajr.168.1.8976941
  25. Hashash JG, Habib-Bein N, Francis FF. MALT lymphoma causing gastric outlet obstruction. ACG Case Rep J 2015;2:70-71 https://doi.org/10.14309/crj.2015.5
  26. Sandrasegaran K, Rajesh A, Rydberg J, Rushing DA, Akisik FM, Henley JD. Gastrointestinal stromal tumors: clinical, radiologic, and pathologic features. AJR Am J Roentgenol 2005;184:803-811 https://doi.org/10.2214/ajr.184.3.01840803
  27. Lim CY, Ong KO. Imaging of musculoskeletal lymphoma. Cancer Imaging 2013;13:448-457 https://doi.org/10.1102/1470-7330.2013.0036
  28. Scarisbrick JJ, Quaglino P, Prince HM, Papadavid E, Hodak E, Bagot M, et al. The PROCLIPI international registry of early-stage mycosis fungoides identifies substantial diagnostic delay in most patients. Br J Dermatol 2019;181:350-357 https://doi.org/10.1111/bjd.17258
  29. Sweet DE, Ward RD, Wang Y, Tanaka H, Campbell SC, Remer EM. Infiltrative renal malignancies: imaging features, prognostic implications, and mimics. Radiographics 2021;41:487-508 https://doi.org/10.1148/rg.2021200123
  30. Anis M, Irshad A. Imaging of abdominal lymphoma. Radiol Clin North Am 2008;46:265-285, viii-ix https://doi.org/10.1016/j.rcl.2008.04.001
  31. Nguyen T, Gupta A, Bhatt S. Multimodality imaging of renal lymphoma and its mimics. Insights Imaging 2022;13:131
  32. Buyukpamukcu M, Varan A, Aydin B, Kale G, Akata D, Yalcin B, et al. Renal involvement of non-Hodgkin's lymphoma and its prognostic effect in childhood. Nephron Clin Pract 2005;100:c86-c91 https://doi.org/10.1159/000085053
  33. Alves AMA, Torres US, Velloni FG, Ribeiro BJ, Tiferes DA, D'Ippolito G. The many faces of primary and secondary hepatic lymphoma: imaging manifestations and diagnostic approach. Radiol Bras 2019;52:325-330 https://doi.org/10.1590/0100-3984.2018.0013
  34. Cubo AM, Soto ZM, Cruz MA, Doyague MJ, Sancho V, Fraino A, et al. Primary diffuse large B cell lymphoma of the uterine cervix successfully treated by combined chemotherapy alone: a case report. Medicine (Baltimore) 2017;96:e6846
  35. Cronin CG, Lohan DG, Blake MA, Roche C, McCarthy P, Murphy JM. Retroperitoneal fibrosis: a review of clinical features and imaging findings. AJR Am J Roentgenol 2008;191:423-431 https://doi.org/10.2214/AJR.07.3629
  36. Garcia-Munoz R, Rubio-Mediavilla S, Robles-de-Castro D, Munoz A, Herrera-Perez P, Rabasa P. Intravascular large B cell lymphoma. Leuk Res Rep 2014;3:21-23
  37. Ong YC, Kao HW, Chuang WY, Hung YS, Lin TL, Chang H, et al. Intravascular large B-cell lymphoma: a case series and review of literatures. Biomed J 2021;44:479-488 https://doi.org/10.1016/j.bj.2020.04.005
  38. Ponzoni M, Campo E, Nakamura S. Intravascular large B-cell lymphoma: a chameleon with multiple faces and many masks. Blood 2018;132:1561-1567 https://doi.org/10.1182/blood-2017-04-737445
  39. Bednarova I, Frellesen C, Roman A, Vogl TJ. Case 257: leiomyosarcoma of the inferior vena cava. Radiology 2018;288:901-908 https://doi.org/10.1148/radiol.2018160821
  40. Bazemore AW, Smucker DR. Lymphadenopathy and malignancy. Am Fam Physician 2002;66:2103-2110
  41. Zhang G, Yang ZG, Bai J, Li Y, Xu HY, Long QH. Leukemias involving abdominal and pelvic lymph nodes: evaluation with contrast-enhanced MDCT. Abdom Imaging 2014;39:1063-1069 https://doi.org/10.1007/s00261-014-0128-7
  42. Zhang G, Yang ZG, Yao J, Deng W, Zhang S, Xu HY, et al. Differentiation between tuberculosis and leukemia in abdominal and pelvic lymph nodes: evaluation with contrast-enhanced multidetector computed tomography. Clinics (Sao Paulo) 2015;70:162-168 https://doi.org/10.6061/clinics/2015(03)02
  43. Vanisri HR, Nandini NM, Sunila R. Fine-needle aspiration cytology findings in human immunodeficiency virus lymphadenopathy. Indian J Pathol Microbiol 2008;51:481-484 https://doi.org/10.4103/0377-4929.43735
  44. Riedel DJ, Rositch AF, Redfield RR, Blattner WA. HIV-associated lymphoma sub-type distribution, immunophenotypes and survival in an urban clinic population. Leuk Lymphoma 2016;57:306-312 https://doi.org/10.3109/10428194.2015.1055483
  45. Komatsu S, Ichikawa D, Kurioka H, Koide K, Ueshima Y, Shioaki Y, et al. Intra-abdominal desmoid tumor mimicking lymph node recurrence after gastrectomy for gastric cancer. J Gastroenterol Hepatol 2006;21:1224-1226 https://doi.org/10.1111/j.1440-1746.2006.04210.x
  46. Sakorafas GH, Nissotakis C, Peros G. Abdominal desmoid tumors. Surg Oncol 2007;16:131-142 https://doi.org/10.1016/j.suronc.2007.07.009
  47. Hosoda K, Shimizu A, Kubota K, Notake T, Hayashi H, Yasukawa K, et al. Gallbladder Burkitt's lymphoma mimicking gallbladder cancer: a case report. World J Gastroenterol 2022;28:675-682 https://doi.org/10.3748/wjg.v28.i6.675
  48. Cantera JE, Alfaro MP, Rafart DC, Zalazar R, Muruzabal MM, Barquin PG, et al. Inflammatory myofibroblastic tumours: a pictorial review. Insights Imaging 2015;6:85-96 https://doi.org/10.1007/s13244-014-0370-0
  49. Farhan M, Bibi A, Zulfiqar O, Imran M, Ali Z. Adult mid ileo-ileal intussusception secondary to inflammatory myofibroblastic tumor (IMT): a case report and literature review. Cureus 2020;12:e10902
  50. Kim YH, Blake MA, Harisinghani MG, Archer-Arroyo K, Hahn PF, Pitman MB, et al. Adult intestinal intussusception: CT appearances and identification of a causative lead point. Radiographics 2006;26:733-744 https://doi.org/10.1148/rg.263055100