Presentation
Abominal pain.
Patient Data
Gynecomastia. Enlarged right cardiophrenic lymph nodes with stranding. Small right effusion. Probable steatosis. Infiltration surrounding the left adrenal. Patchy infiltration of the kidneys, L>R (see liver windows). Spleen is mildly enlarged.
Omental stranding. Small ascites with mild peritoneal thickening. Large, cavitating circumferential soft tissue mass of the cecum without obstruction of the bowel.
Substantial improvement of multifocal disease including cardiophrenic lymph nodes, left adrenal infiltration, peritoneal disease and primary cecal tumor.
Case Discussion
Typical findings of a large bowel lymphoma include a circumferential, soft-tissue density mass that causes cavitation of the bowel (due to myenteric plexus infiltration) but without obstruction. Findings of more widespread disease make this case high yield for education and include cardiophrenic lymph nodes, soft tissue infiltration surrounding the left adrenal gland, bilateral renal infiltration (see liver window images), and omental/peritoneal disease (lymphomatosis).
It is important to suggest lymphoma in the proper setting rather than have such a patient proceed to unnecessary surgery or partial colectomy, which is highlighted by the rapid response to chemotherapy in just two weeks.
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