IRIA- 1192

Case Discussion A 46 year old male with complaints of -Dysphagia x 2 weeks -Epigastric Pain x 2 weeks -Vomiting x 40 hours An upper gastrointestinal endoscopy was done which revealed a gastro-duodenal junction growth invading the cardia of stomach. Histopathology confirmed the diagnosis of Diffuse Large B cell type of Non-Hodgkins Lymphoma.

Materials and methods Routine CT abdomen was done giving 30ml diatrizoate sodium in 1500 ml of water as oral contrast and 80 ml non ionic contrast at the rate of 3.5ml/sec as iv contrast and triple phase CT study done

large heterogenous, lobulated enhancing mass measuring 140 x 138 x 131 mm in the lesser sac causing extraneous compression over the body and antrum of stomach. The mass was encircling the stomach and the gastro-oesophageal junction with severe luminal narrowing at the gastro-oesophageal junction.

The mass was encasing the splenic artery, lesser gastric artery and the splenic vein leading to splenic vein thrombosis. The omentum appeared diffusely thickened and nodular. The splenic vein is completely thrombosed.

The mass is extending upto the level of the left renal vessels, partially encassing the left renal artery and vein, with focal narrowing of left renal vein.

Most common differential diagnosis 1)Peritoneal carcinomatosis 2)Tuberculous peritonitis However, ascites without any loculation or septation and diffuse distribution of enlarged lymph nodes are helpful signs of peritoneal lymphomatosis.

DESCRIPTION Lymphoma can occur at any site in the body, but diffuse and extensive involvement of the peritoneal cavity is rare. Approximately 10% of non-Hodgkin’s lymphomas involve the gastrointestinal tract. However, multiple intra-abdominal organ infiltration or disseminated peritoneal lymphoma, called peritoneal “lymphomatosis”, receives much less attention in the literature than peritoneal carcinomatosis

Most primary lymphomas complicated with ascites or peritoneal lymphomatosis are located in the abdomen and present as extranodal involvement. It seems that B-cell lymphomas account for a large part of the pathologic findings, and most gastrointestinal lymphomas are localized and express B-cell phenotypes. Gastrointestinal Diffuse Large B Cell Lymphoma is the most frequent extranodal lymphoma, with the most common location being below the diaphragm, followed by the small intestine and colon–rectum.