3. DEFINITION
Lymphoma Is A Type Of Cancer That Arises
In the Immune Cells Called As Lymphocytes.
Extra nodal Lymphoma Is Term Used To
Describe Lymphomas Occuring Outside The
Lymphatic Tissues.
4. INTRODUCTION
Distinct group of lymphoma that primarily arises in lymphoid
tissue of the bowel rather than in lymph nodes
G I lymphoma may either represent secondary involvement by
systemic disease or primary malignancy confined to the GI tract
GIT-lymphoid Elements Seen In The Lamina Propria and Sub
Mucosa
Secondary GI Involvement Is Common
Primary Lymphomas Involve Only One Site
5. Five Criteria Put Forth By Dawson et al
To Diagnose Primary GI Lymphomas
No Palpable Superficial Lymph Nodes
Normal CXR
WBC Count are Normal
At Laparotomy Alimentary Tract Is Involved With Lymph node
Involvement if Any confined to the drainage area of gut
involved
No Spleen Or Liver Involvement
Advanced Stages Mimic Secondary GI Lymphoma
6. Gastrointestinal Lymphoma
Most Commonly Non-hodgkin Lymphomas That Are High Grade
Large Cell Or Immunoblastic Cell Types
Burkitt More Common In Pediatric Patients
Most Common Symptoms: Abdominal Pain, Weight Loss, fever,
Anemia
T-cell Lymphoma If In GIT Occurs In Small Bowel
(64%)esp.Duodenum+jejunum.
7. Oesophagus
Esophagus: Least common site within GI tract
Accounts for only about 1% of all cases
Usually non-Hodgkin & less commonly Hodgkin
Patients almost always have generalized lymphoma
Primary esophageal lymphoma seen in AIDS cases
8. Imaging
Usually contiguous spread from gastric
cardia/fundus to distal esophagus
Polypoid or ulcerated mass or infiltrating stricture
Submucosal infiltration (less common)
Enlarged, tortuous longitudinal folds mimicking varices
Diagnosis: Endoscopy with deep esophageal biopsy
10. gastric lymphoma represents the most common
site of extra nodal lymphoma, accounting for 25%
of all such lymphomas, 50% of all gastrointestinal
lymphomas, but comprise only 1-5% of all gastric
malignancies .
Typically primary gastric lymphoma occurs in
adults in the 6th decade of life, without gender
predilection. Secondary gastric lymphoma matches
the demographics of the underlying lymphoma.
Gastric lymphoma
11. Pathology
Three distinct types of gastric lymphoma are recognized :
low-grade MALT lymphoma : 60% of all primary gastric
lymphomas
primary sporadic lymphoma : vast majority are B-cell non-
Hodgkins lymphoma
secondary involvement of the stomach by systemic lymphoma
(usually high grade)
Mucosa-associated lymphoid tissue (MALT) lymphoma and
are strongly associated with Helicobacter pylori (85 - 98% of
cases). These are low-grade lymphomas and may regress following
treatment of Helicobacter infection .
12. Radiographic features Gastric
lymphoma
Fluoroscopy : Barium meal
Appearances vary from normal, to grossly abnormal.
Possible appearances include:
bull's eye appearance due to central ulceration
filling defects
thickened gastric rugae
linitis plastica
13. Computed tomography
Typically gastric lymphomas demonstrate marked
thickening of the stomach wall (2-4cm) with extensive
lateral extension of the tumour (i.e. along the wall of
the stomach) representing submucosal spread.
14. Submucosal spread may
Encompasses the majority of the stomach giving a
linitis plastica appearance.
Can extend across the pylorus into the duodenum
and superiorly into the oesophagus.
uncommon for lymphoma to result in
gastric outlet obstruction
15. UPPER GI SERIES SHOWS MASSIVE NODULAR THICKENINGS
OF GASTRIC WALL/FOLDS; LYMPHOMA
26. GI lymphoma staging
I: Tumor confined to bowel wall
II: Limited nodal spread to local nodes
III: Widespread nodal mets
IV: Spread to bone marrow, solid viscera,
liver
27. Small bowl
1/5 of all small bowel malignancies.
Most common malignant small bowel tumor.
Multiple sites involvmentin1/5.
Most common cause of INTUSSUSEPTION in
children>6yrs
37. Mesentry And Omentum
Infiltration and thickenining of mesentry
Omental caking
Nodular or strand like soft tissue density
Calcified foci
Rounded mass
