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Lymphomas Lymphoma in the small bowel may be primary or secondary. A diagnosis of a primary intestinal lymphoma requires histologic confirmation in a clinical setting in which palpable adenopathy and hepatosplenomegaly are absent and no evidence of lymphoma is seen on chest radiograph, CT scan, or peripheral blood smear or on bone marrow aspiration and biopsy. Symptoms referable to the small bowel are present, usually accompanied by an anatomically discernible lesion. Secondary lymphoma of the small bowel consists of involvement of the intestine by a lymphoid malignancy extending from involved retroperitoneal or mesenteric lymph nodes (Chap. 105). Primary intestinal lymphoma. | Chapter 087. Gastrointestinal Tract Cancer Part 15 Lymphomas Lymphoma in the small bowel may be primary or secondary. A diagnosis of a primary intestinal lymphoma requires histologic confirmation in a clinical setting in which palpable adenopathy and hepatosplenomegaly are absent and no evidence of lymphoma is seen on chest radiograph CT scan or peripheral blood smear or on bone marrow aspiration and biopsy. Symptoms referable to the small bowel are present usually accompanied by an anatomically discernible lesion. Secondary lymphoma of the small bowel consists of involvement of the intestine by a lymphoid malignancy extending from involved retroperitoneal or mesenteric lymph nodes Chap. 105 . Primary intestinal lymphoma accounts for 20 of malignancies of the small bowel. These neoplasms are non-Hodgkin s lymphomas they usually have a diffuse large-cell histology and are of T cell origin. Intestinal lymphoma involves the ileum jejunum and duodenum in decreasing frequency a pattern that mirrors the relative amount of normal lymphoid cells in these anatomic areas. The risk of small-bowel lymphoma is increased in patients with a prior history of malabsorptive conditions e.g. celiac sprue regional enteritis and depressed immune function due to congenital immunodeficiency syndromes prior organ transplantation autoimmune disorders or AIDS. The development of localized or nodular masses that narrow the lumen results in periumbilical pain made worse by eating as well as weight loss vomiting and occasional intestinal obstruction. The diagnosis of small-bowel lymphoma may be suspected from the appearance on contrast radiographs of patterns such as infiltration and thickening of mucosal folds mucosal nodules areas of irregular ulceration or stasis of contrast material. The diagnosis can be confirmed by surgical exploration and resection of involved segments. Intestinal lymphoma can occasionally be diagnosed by peroral intestinal mucosal biopsy but since the disease mainly .
