Presentation
Abdominal pain lasting for one month, accompanied by vomiting, constipation, and fever.
Patient Data
Marked distention of intestinal loops is observed in the upper mid abdomen. There is an impression of a paucity of gas in the right lower quadrant. No pneumoperitoneum or portovenous gas is detected, and there are no discrete intraabdominal calcifications.
There is a long segment of approximately 13 cm of abnormal bowel loop demonstrating a severely thickened bowel wall, with a hypoechogenic muscular layer measuring up to 1.4 cm. Small volume free fluid and some lymph nodes were also noted.
Differentials considered at this time include inflammatory or infectious etiology, or an infiltrative neoplastic process, likely intestinal lymphoma type.
Redemonstration reveals the persistently thickened ileal wall without an abrupt transition site. The thickened intestinal wall also exhibits small cystic central areas without contrast medium uptake, corresponding to regions of necrosis. The intestinal wall has an average diameter of 3.0 cm, and multiple lymph nodes are also noted.
The liver displays diffuse heterogeneous enhancement, likely due to the late-stage images. Subsequent ultrasound and staging CT scans show no evidence of lesions suggestive of metastasis.
The patient underwent surgery. In the exploratory videolaparatomy, where there is evidence of abdominal mass with lymphoma-type characteristics involving the large intestine, small intestine, and omentum transcavity, the omentum with infiltrative lymphatic changes for the latter performed a partial omentectomy.
The histopathological report reported Burkitt's lymphoma.
The staging CT scan did not show metastatic lesions at the pulmonary, abdominal, or osseous levels. Liver enhancement is homogeneous, with no lesions suggestive of metastasis.
The patient received chemotherapy treatment
The computed tomography 6 months after diagnosis and after receiving chemotherapy shows a diminution of the lesion at the ileum level described in the initial study.
Case Discussion
Burkitt's lymphoma is a highly aggressive malignancy with a higher incidence in pediatric and immunocompromised patients.
Abdominal involvement predominates at presentation and is usually extranodal.
Although the diagnosis of Burkitt's lymphoma is confirmed pathologically, imaging plays a critical role.
The initial imaging modality for abdominal Burkitt's lymphoma may be through ultrasound, mainly in the case of palpable masses, CT allows assessment of disease severity and dissemination for tumor staging.
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