Extranodal lymphomas of abdomen and pelvis: imaging findings and differential diagnosis

18F-FDG PET/CT assists the diagnosis of primary pancreatic lymphoma: Two case reports and literature review

Primary pancreatic lymphoma (PPL) is a rare malignancy, which is defined as a mass centered in pancreas with involvement of contiguous lymph nodes and distant spread may exist. Accurate diagnosis of PPL prior to pathological confirmation remains challenging, underscoring the critical significance of preoperative imaging assessments. This case report collected two instances of PPL that underwent initial evaluation via 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) between August 2021 and July 2022. Correspondingly, pertinent literature encompassing 18F-FDG PET/CT data related to PPL was meticulously reviewed. Including our aforementioned pair of cases, a cumulative total of 25 instances of PPL were assembled. The distinctive profile of 18F-FDG PET/CT images of PPL predominantly manifests as hypermetabolic lesions with diminished density. Primarily characterized by singular lesions and comparatively substantial volumetric dimensions, a total of eleven cases revealed contiguous lymph node engagement, with five instances displaying distant dissemination encompassing lymph nodes in multiple locations. Amongst these, ten patients underwent sequential 18F-FDG PET/CT follow-up post-intervention. In comparison to pancreatic carcinoma, PPL lesions exhibited heightened hypermetabolism, augmented volumetric proportions, and distinct patterns of distant metastasis. This study indicates that the pivotal role of 18F-FDG PET/CT in the diagnosis and assessment of therapeutic efficacy in PPL is unequivocal. Combined with the clinical attributes of patients, the integration of 18F-FDG PET/CT augments the differential diagnostic capacity differentiating PPL from pancreatic carcinoma.

Primary hepatopancreatobiliary lymphoma: Pathogenesis, diagnosis, and management

Primary hepatopancreatobiliary lymphoma (PHPBL) is extremely rare, which is defined as a lympho-proliferative disease confined to the hepatobiliary system and pancreas without any involvement of lymph nodes, bone marrow, or other organs. The clinical and imaging manifestations of PHPBL are variable and non-special, which are akin to those of tumors of the hepatobiliary and pancreatic systems. The overall prognosis and management of PHPBL differ from those of other tumors in the hepatobiliary system and pancreas. Proper diagnosis and prompt treatment are essential for improving clinical outcomes. Due to its rarity, the optimal treatment has not been issued. However, combination chemotherapy is considered as a standard treatment for them. This review provides an overview of the pathogenesis, diagnosis, pathology, and management of PHPBL and offers clinicians the diagnosis and management schedule for PHPBL.

Complications of lymphoma in the abdomen and pelvis: clinical and imaging review

Involvement of the abdomen and pelvis is common in lymphoma. Nodal and extranodal abdominal and pelvic lymphoma may present with various complications. Complications are most common in high-grade lymphomas, especially diffuse large B-cell lymphoma. Complications may occur as the initial manifestation of lymphoma, during treatment course, or late following complete disease remission. Most complications are associated with worse prognosis and increased mortality. Imaging is essential in evaluation of disease extent and diagnosis of complications. Therefore, radiologists should be familiar with the clinical context and imaging features of abdominal and pelvic lymphoma complications. We provide a comprehensive, organ system-based approach, and clinical and imaging review of complications of abdominal and pelvic lymphoma along with radiologic images of illustrated cases of the most commonly encountered complications.

Non-Hodgkin Lymphoma Imaging Spectrum in Children, Adolescents, and Young Adults

In children, adolescents, and young adults (CAYA), non-Hodgkin lymphoma (NHL) is characterized by various age-related dissimilarities in tumor aggressiveness, prevailing pathologic subtypes, and imaging features, as well as potentially different treatment outcomes. Understanding the imaging spectrum of NHL in CAYA with particular attention to children and adolescents is critical for radiologists to support the clinical decision making by the treating physicians and other health care practitioners. The authors discuss the currently performed imaging modalities including radiography, US, CT, MRI, and PET in the diagnosis, staging, and assessment of the treatment response. Familiarity with diagnostic imaging challenges during image acquisition, processing, and interpretation is required when managing patients with NHL. The authors describe potentially problematic and life-threatening scenarios that require prompt management. Moreover, the authors address the unprecedented urge to understand the imaging patterns of possible treatment-related complications of the therapeutic agents used in NHL clinical trials and in practice. Online supplemental material is available for this article. ^©RSNA, 2022.

Renal Lymphoma Mimicking a Retroperitoneal Hematoma

We report the case of a 65-year-old female with an atypical presentation of renal lymphoma at computed tomography (CT), which was initially misinterpreted as a retroperitoneal hematoma. This case highlights the importance to keep a high level of suspicion in order to make a prompt diagnosis since treatment strategies differ significantly.

Diagnostic approach to primary retroperitoneal pathologies: what the radiologist needs to know

Retroperitoneal soft tissue lesions represent a wide range of disease processes with overlapping imaging findings. Familiarity with the CT and MR characteristics of these conditions is important to guide clinical evaluation. We review the tissue types, characteristic clinical, demographic, and imaging features of retroperitoneal tumors and tumor-like non-neoplastic conditions with CT and MR correlation, including anatomic and imaging clues, and provide a diagnostic approach to aide the radiologist in making a specific diagnosis.

Inferior vena cava-syndrome

Inferior vena cava syndrome (IVCS) is caused by agenesis, compression, invasion, or thrombosis of the IVC, or may be associated with Budd-Chiari syndrome. Its incidence and prevalence are unknown. Benign IVCS is separated from malignant IVCS. Both cover a wide clinical spectrum reaching from asymptomatic to highly symptomatic cases correlated to the underlying cause, the acuity, the extent of the venous obstruction, and the recruitment and development of venous collateral circuits. Imaging is necessary to determine the underlying cause of IVCS and to guide clinical decisions. Interventional therapy has changed the therapeutic approach in symptomatic patients. This article provides an overview over IVCS and focuses on interventional therapeutic methods and results.

[Extranodal abdominal lymphomas]

BACKGROUND

Extranodal manifestations occur in up to 40% of non-Hodgkin lymphomas. The prevalence of extranodal involvement has increased.

OBJECTIVES

A comprehensive overview on lymphoma involvement in the parenchymatous abdominal organs, the gastrointestinal tract, and the peritoneal cavity under due consideration of clinical implications is given.

MATERIALS AND METHODS

A selective literature search with analysis of dedicated original research articles and reviews was carried out. Clinical guidelines are discussed.

RESULTS

Extranodal abdominal lymphoma involvement usually occurs secondarily in advanced disease. Sites involved most frequently are the liver and the gastrointestinal tract. Extranodal abdominal lymphoma involvement is more common in the immunocompromised patient.

CONCLUSION

Imaging findings of extranodal abdominal lymphoma are variable. Lymphoma is an important differential diagnosis to be considered in unclear tumor diseases.

Unicentric or Multicentric Castleman disease? A case report of a pelvic intraperitoneal mass in a middle aged woman

Castleman Disease is a lymphoid disorder characterized by the presence of an enlarged or abnormal lymph node/lymphatic tissue. The disease is classified into unicentric or multicentric variants. The unicentric form is a benign disorder that is usually asymptomatic and consists of a single lymphoid mass that is predominantly located in the mediastinum, but can also rarely develop in the neck or abdomen. The multicentric type involves more than one lymphatic station and is related to the presence of type B symptoms (fevers, night sweats and weight loss), HIV/HHV8 infection and increased serum IL-6 levels. We present the case of an unusual pelvic intraperitoneal manifestation of Castleman Disease in a 52-year-old caucasian woman who showed clinical, radiological, histological and laboratory findings common to both Unicentric and Multicentric Castleman Disease.