Imaging Features of Nasal-Type Natural Killler/T-cell Lymphomas: Frequent Involvement of Skin and Subcutaneous Tissue

PURPOSE: We wanted to evaluate the radiologic characteristics of nasal-type NK/T cell lymphomas. MATERIALS AND METHODS: We reviewed twenty-one cases of pathologically proven nasal-type NK/T-cell lymphomas. CT scans were obtained for 21 patients, MR image were obtained for 3 patients, and both CT and MR scans were obtained for 3 patients. The imaging features regarding patterns of the masses, extension to adjacent tissue, bony changes and the degree of contrast enhancement were evaluated. RESULTS: All of the 21 patients had diffuse mucosal thickening and 12 patients (12/21, 57%) also had polypoid masses. Nasal cavity lesions showed extension to the adjacent tissue in 20 cases (20/21, 95%). Adjacent bone erosion or destruction was noted in 14 cases (14/21, 67%) and the bone destruction was mild. CONCLUSION: Nasal-type NK/T-cell lymphomas revealed a tendency to involve the superficial soft tissue and to extend into the adjacent structures. The typical imaging features of nasal-type NK/T-cell lymphoma were diffuse infiltrative lesion with or without polypoid masses in the nasal cavity and frequently extension to adjacent soft tissue, and especially the subcutaneous tissue.

Peritoneal Lymphomatosis: Case Report

Peritoneal lymphomatosis is a rare manifestation of high grade lymphomas. Although it is difficult to differentiate peritoneal lymphomatosis from other peritoneal diseases such as peritoneal carcinomatosis and leiomyomatosis clinically and radiologically, it should be included in differential diagnosis because the disease is curable with chemotherapy. Consequently, radiologic diagnosis plays a very important role in the detection of this disease. We experienced two cases of peritoneal lymphomatosis with primary gastrointestinal lymphomas in the distal ileum. The two patients were 25 and 50-year-old males. Abdominal CT, ultrasound and barium study were performed on both patients. Both patients had non-Hodgkin's lymphoma confirmed with open or sonographically guided biopsies. Although radiologic appearances overlapped, characteristic findings of long-segmental circumscribed annular mass, aneurysmal luminal dilatation, small to moderate amount of ascites without septation or loculation, diffuse involvement of mesentery, omentum and peritoneum, and enlarged lymph nodes were helpful in narrowing the range of possible diagnoses.

High Grade MALT Lymphoma of the Ileum in a Child Presenting as Intussusception: A Case Report

Lymphoma is the third most common childhood malignancy after leukemia and brain tumor. In contrast to adult non-Hodgkin's lymphoma, that occurring in children is usually found extranodally. The most common site is the abdomen, including the gastrointestinal tract, kidney and pancreas, and the next most common is the extranodal head and neck. Gastrointestinal non-Hodgkin's lymphoma in adults is usually considered to be MALT lymphoma, a distinct B-cell type, but the occurrence of this variety in the small bowel of children is relatively rare. We report a case of high-grade MALT lymphoma occurring in a nine-year-old boy who presented with ileoileal intussusception.

Tracheal Involvement of Bronchus-Associated Lymphoid Tissue Lymphoma: A Case Report

Primary malignant tumors of the trachea are rare, the most prevalent histologies beeing squamous cell and adenoid cystic carcinoma. A review of the literature revealed only ten cases of primary tracheal or bronchial non-Hodgkin's lymphoma. We describe a case in which tracheal involvement of bronchus-associated lymphoid tissue lymphoma, a subtype of non-Hodgkin's lymphoma, occurred.

Nodular Hepatic Involvement of Malignant Lymphoma:Enhancement Patterns on Dual Phase CT

PURPOSE: To evaluate the enhancement patterns revealed by dual-phase CT, and other characteristic features of nodular hepatic involvement of malignant lymphoma, and to determine the usefulness of this imaging modality in the differentiatial diagnosis of hepatic masses. MATERIALS AND METHODS: Seven cases that pathologically confirmed as nodular hepatic involvements of malignant lymphoma among patients who underwent dual-phase CT for the staging or follow-up of malignant lymphoma, and two that confirmed as primary lymphoma among patients who underwent dual-phase CT for differential diagnosis of nodular hepatic masses were evaluated. There were eight cases of non-Hodgkin 's lymphoma (NHL) and one of Hodgkin 's disease(HD). The findings were analysed in terms of the number, size, and contour pattern of the masses, the enhancement pattern seen on dual-phase CT, and whether or not the vascular structure of the mass was normal. RESULTS: Primary lymphomas were present in two patients(single mass, n=1; multiple nodules, n=1) and secondary lymphomas in seven (single mass, n=6; multiple nodules, n=1). The maximum size of main masses was mean 5.1(range, 2-12) cm, and the contor was smooth in three cases, ill-defined in three and lobulated in three. During the early phase, five patients showed homogeneous low attenuation, and heterogeneous enhancement was observed in four. During the late phase, three of the five showed peripheral enhancement and the other two showed the same low attenuation, while two of the four showed central low attenuation, one showed iso attenuation, and one showed heterogeneous enhancement. In four of the patients whose main mass was larger than the mean, vascular shadow passed through the mass (left portal vein, n=2; branches of the right portal vein, n=1; and branches of the hepatic artery, n=1). CONCLUSION: Where dual-phase CT demonstrated nodular hepatic involvement of malignant lymphoma, contrast enhancement varied and so differentiation from other hepatic masses such as metastatic adenocarcinoma and hepatocellular carcinoma was therefore difficult. Homogeneity and a lack of necrosis, even though a mass is large and has a smooth well-defined contour, no capsulation and normal vasculature, may suggest the nodular hepatic involvement of malignant lymphoma.

Bronchus-Associated Lymphoid Tissue (BALT) Lymphoma of the Lung Showing Mosaic Pattern of Inhomogeneous Attenuation on Thin-section CT: A Case Report

The authors present a case of histologically proven bronchus-associated lymphoid tissue (BALT) lymphoma of the lung in a patient with primary Sjogren's syn-drome that manifested on thin-section CT scan as a mosaic pattern of inhomoge-neous attenuation due to mixed small airway and infiltrative abnormalities

Low Grade MALT Lymphoma of Rectum: A Case Report

We report a case with low-grade MALT lymphoma of the rectum in a 32-year-old man. Primary lymphoma of thecolon is rare and comprises less than 1 % of large bowel malignancies. Recently, large part of colonic lymphomahave been shown to be MALT lymphoma, which is a distinct type of B-cell lymphoma. The radiologic findings of thiscase are mucosal nodularity with shallow ulcers in the rectum, as seen on bar-ium enema, and rectal wallthickening, as seen on CT. There was no evidence of intra-abdominal lym-phadenopathy nor hepatosplenomegaly. Suchradiologic findings are rather similar to the findings in cases of inflammatory bowel disease, rending thedifferential diagnosis difficult.

Borrmann Type IV Adenocarcinoma versus Gastric Lymphoma: Spiral CT Evaluation

PURPOSE: To distinguish the spiral CT findings of Borrmann type IV adenocarcinoma from those of gastric lymphoma with diffuse gastric wall thickening. MATERIALS AND METHODS: We retrospectively reviewed the spiral CT scans of 30 patients with Borrmann type IV adenocarcinoma and nine with gastric lymphoma with diffuse gastric wall thickening. In all patients the respective condition was pathologically confirmed by gastrectomy. CT scanning was performed after peroral administration of 500-700ml of water. A total of 120-140ml bolus of nonionic contrast material was administered intravenously at a flow rate of 3ml/sec and two-phase images were obtained at 35-45 sec(early phase) and 180 sec(delayed phase) after the start of bolus injection. Spiral CT was performed with 10mm collimation, 10mm/sec table feed and 10mm reconstruction. We evaluated the degree and homogeneity of enhancement of thickened entire gastric wall, and the enhancement pattern of gastric inner layer, as seen on earlyphase CT scans. On early and delayed views, the thickness of gastric wall and the presence of perigastric fat infiltration were determined. The enhancement patterns of gastric inner layer were classified as either continuous or discontinuous thick enhancement, thin enhancement, or nonenhancement. RESULTS: The thickness of gastric wall was 1.2-3.5cm(mean 2.2cm) in cases of adenocarcinoma and 1.2-7.6c m (mean 4cm) in lymphoma. Perigastric fat infiltration was seen in 24 patients with adenocarcinoma(80 %) and four with lymphoma(44%). In those with adenocarcinoma, the degree of enhancement of entire gastric wall was hyperdense in fifteen patients(50%) and isointense in eleven (37 %). Seven patients with lymphoma(78 % ) showed hypodensity. In those with adenocarcinoma, continuous thick enhancement of gastric inner layer was seen in 18 patients(60 %) and discontinuous thick enhancement in nine(30%). In lymphoma cases, no thick enhancement was observed. Thin enhancement of gastric inner layer was demonstrated in three patients with adenocarcinoma( 10 %) and two with lymphoma(22 %). In seven patients with lymphoma(78 %), there was no enhancement. CONCLUSION: The following early-phase findings are highly suggestive of gastric lymphoma: a gastric wall thickness of more than 3 cm; no or minimal perigastric fat infiltration, hypodense enhancement of thickened entire gastric wall; and no or thin enhancement of gastric inner layer.

CT and MR Imaging of Primary Nasal Lymphoma: Usefulness at Initial Diagnosis and Follow-up

PURPOSE: To describe CT and MR findings of Primary nasal NK/T-cell lymphoma and to evaluate the usefulness ofCt and MR imaging for initial diagnosis and during follow-up. MATERIALS AND METHODS: Thirteen patients withbiopsy-proven primary nasal NK/T-cell lymphoma (M:8, F:5;age 30-78, mean:47.3 years) were included in this study.CT scans were obtained in seven patients and MR images in ten, and both CT and MR images in four. Duringfollow-up, CT images were obtained in four patients, MR images in eight, and both types of image in two. Signalintensity or attenuation, location, and shape of the tumor were assessed on CT and MR images, which were alsocompared in terms of evaluation of the extent of the tumor and the assessment of residual tumor during follow-up. RESULTS: Enhanced CT scans showed slightly lower(6/7) or iso-attenuation (1/7) or the tumor than of the wall ofthe nasal cavity. In all cases, the tumor was of slightly lower signal intensity on T2WI and gadolinium-enhancedT1WI than nasal cavity mucosa. Infiltrative wall thickening of the nasal cavity (13/13) and a polypoid mass (5/13)were demonstrated on CT and MR images. The tumor margin was partially indistinct (6/7) or distinct (1/7) oninitial CT, but distinctily identified on initial MR images in all cases. During follow-up, MR was superior to CTfor the assessment of residual tumor in two patients. CONCLUSION: Infiltrative wall thickening of the nasalcavity may be a characteristic feature of primary nasal NK/T-cell lymphoma, and MR images were superior to CT forthe assessment of tumor extent and for the diagnosis of residual tumor during follow-up.

Primary Sinonasal Lymphoma: CT and MR Findings

PURPOSE: To evaluate the radiologic characteristics of sinonasal lymphoma, as seen on CT and MR MATERIALS AND METHODS: In eighteen patients with pathologically-proven non-hodgkin's lymphoma in the sinonasal cavity, CT andMR images were retrospectively reviewed. CT and MR findings were analyzed for tumor location, degree ofinfiltration into the adjacent structure, degree of enhancement, and the presence of bone change. Tthe last-namedwas classified as one of four types : complete destruction, segmental destruction, thinning, or sclerotic change. RESULTS: Masses in the nasal cavity (N=17) and ethomoid sinus (N=16) were most common, and the remainder wereaccounted for by maxillary sinus(N=6), sphenoid sinus(N=2), and frontal sinus(N=2), In 16 cases, the involvementof more than two sinonasal compartments was demonstrated ; the deensity of these masses was shown by precontrastCT to be similar to that of facial muscles ; affer contrast enhancement, all except one (15/16) showed homogeneousenhancement. Tumor infiltration of the adjacent structure was identified in the nasopharynx(N=9), anterior buccalspace(N=7), orbit(n=6), subcutaneous layer of the cheek(N=3), and infratemporal fossa(N=3). Direct extension ofthe tumor from the nasal fossa to the nasopharynx or anterior buccal space was demonstrated. Among 18 cases, bonechange was seen in 12, segmental destruction in eight, complete destruction in six, thinning in two, and scleroticchange in two. Four of the six cases with complete bone destruction showed hyperdense linear density within themass ; CT showed that after treatment, bony regrowth had occurred. In two cases, MRI showed intermediate signalintensity of the masses on T1WI, iso or slightly high signal intensity on T2WI, and moderate enhancement onpostcontrast T1WI. CONCLUSION: On CT, sinonasal lymphoma usually showed homogenous enhancement, extensivelyinfiltration of the adjacent structure, but no massive bone destruction. Hyperdense linear density, suggestingghost bone and seen in spite of massive bone destruction, may be a characteristic finding of sinonasal lymphoma.

Nasal Non-Hodgkin's Lymphoma: CT Findings

PURPOSE: To describe the characteristics of CT findings in nasal lymphoma. MATERIALS AND METHODS: We retrospectively reviewed CT findings and pathologic findings of eight patients (six males and two females) aged between 24 and 68 years with pathologically-proven nasal lymphoma. We analyzed mass location, laterality, size, margin, mass effect, adjacent bony change and contrast enhancement pattern. RESULTS: All eight cases werenon-Hodgkin's lymphoma, intermediate grade, diffuse large cell type. Seven cases were B-cell type and one was T-cell. In all cases, tumors were located in the medial wall of the inferior turbinate. In four cases, they were also found in the anterior ethmoidal sinus, and in one case, in the nasal septum. The mean size of the main mass was 3.3 cm. In seven cases, tumors were unilateral (one on the right; six on the left), and in the remaining case, bilateral. In six cases tumor margin was smooth and in two cases focal nodularity was seen. In two cases there was no bony change, and in four, there was mucosal thickening along the nasal septum; in one of these four, minimal bony erosion was also found. In the other two cases, bony destruction was seen, and tumors were very large (7 cm in diameter) or bilterally located. In three cases, the nasal septum was displaced by the mass. In all cases with bony change, the nasal septum was involved. All tumors were homogeneously well enhanced after IV contrast administration. CONCLUSION: The main CT findings of nasal non-Hodgkin's lymphoma were smooth margin, unilateral location (mainly in the medial wall of the inferior turbinate and growing to the medial side without bony destruction) mucosal thickening along the nasal septum and clear homogeneous enhancement after IV contrast administration. These characteristics will help diagnosis, help determine the appropriate region for radiation and other appropriate therapy, and facilitate prognosis in patients with nasal non-Hodgkin's lymphoma.

Hepatic Lymphoma: CT and Sonographic Findings

PURPOSE: To describe the computed tomographic (CT) and sonographic (US) findings of hepatic lymphoma presenting as focal lesion(s). MATERIALS AND METHODS: From May 1989 to August 1996, CT (n = 9) and US (n = 7) findings of ten patients with hepatic lymphoma were retrospectively analyzed. Three were suffering from primary non-Hodgkin's lymphoma (NHL), six had secondary NHL and one had Hodgkin's disease (HD). Findings were analysed with respect to number and contour of the lesions, associated lymphadenopathy or splenic lesion, and the presence or absence of normal vascular structure in the mass. In addition, echogenicity of the lesion and the presence of a capsule or halo was analyzed on US and enhancement pattern was analyzed on CT. RESULTS: Single nodular type lesions were seen in six patients (three primary NHL, three secondary NHL) and the multinodular type were seen in four (three secondary NHL and one HD). Contour was smooth in two patients with secondary NHL and ill-defined or lobulated in all other patients. Lymphadenopathy was seen in three of six patients with secondary NHL, and splenic lesions were seen in the other three. The echogenicity of the mass was mixed in three, homogeneously low in two and target shaped in two. The enhancement pattern was highly variable. CONCLUSION: Hepatic lymphoma has variable radiologic features, so differentiation from other tumorous conditions of the liver was difficult. A history of lymphoma in other part(s) of the body, associated splenic lesion(s) or abdominal lymphadenopathy or normal vasculature within a tumor may suggest the presence of hepatic lymphoma.

Spontaneous Perforation of Small Bowel Lymphoma Causing Massive Pneumoperitoneum: A case Report

The gastrointestinal lymphoma is a well known entity for bleeding or perforation during treatment, but spontaneous perforation is not common. We report the CT findings of an unusual case of small bowel lymphoma which presented with massive pneumoperitoneum following spontaneous perforation.