Non-Hodgkin lymphoma: computed tomographic demonstration of unusual extranodal involvement

High-grade B-cell lymphoma, not otherwise specified, presenting as primary peritoneal lymphomatosis and successfully treated with dose-adjusted EPOCH-R

Peritoneal lymphomatosis (PL) is a rare lymphoma-associated condition defined as the dissemination of lymphoma cells in the peritoneum. An 82-year-old man presented with abdominal pain, heartburn, and high fever. Radiological findings, including positron emission tomography-computed tomography (PET-CT), and gastrointestinal fiberscopy, showed diffuse thickening of the peritoneum, omentum, and mesentery; however, no lymphadenopathy, hepatosplenomegaly, or gastrointestinal lesions were observed. Under suspicion of peritonitis carcinomatosa of unknown origin, exploratory laparoscopy was performed that revealed multiple white nodules and masses on the surfaces of the peritoneum, mesentery, and intestinal serosa. The histopathological and cytogenetic findings of the peritoneum revealed high-grade B-cell lymphoma, not otherwise specified, and a gain of MYC by fluorescence in-situ hybridization. The patient was treated with two cycles of R-CHOP therapy, followed by six cycles of dose-adjusted EPOCH-R therapy, and a complete metabolic response was confirmed by PET-CT. Since there are no specific radiological findings to confirm the diagnosis of PL, a histopathological diagnosis is usually required. Most PL exhibit an aggressive lymphoma phenotype and can be cured by appropriate chemotherapy. Therefore, early diagnosis and treatment are desirable.

Non-Hodgkin's Lymphoma Presenting as Isolated Peritoneal Lymphomatosis: A Case Report and Literature Review

Peritoneal lymphomatosis is extremely rare and associated with poor prognosis. Most practitioners only pay more attention to peritoneal carcinomatosis. However, peritoneal lymphomatosis can be neglected and misdiagnosed. We report a teenager with 10 days of abdominal distension and pain accompanied by computed tomography scan suggesting diffuse thickening of the peritoneum and omentum and abdominopelvic effusion. Tuberculous peritonitis and peritoneal carcinomatosis were initially suspected. However, it was finally confirmed as non-Hodgkin’s B-cell lymphoma by omentum biopsies. He achieved complete remission after chemotherapy and autologous stem cell transplantation. But unfortunately, he suffered a relapse and died 10 months after diagnosis. Following a review of the literature, it can be concluded that the discovery of lymphomatosis in peritoneum is a rare finding. Lymphoma should be considered in the differential diagnosis of unexplained peritoneal thickening on computed tomography, and this case emphasizes the importance of early pathological diagnosis to make sure that the right treatment can be started opportunely.

Peritoneal lymphoma with ascites mimicking portal hypertensive ascites: A case report

RATIONALE

Lymphoma with an initial manifestation of ascites and peritoneal invasion is rare.

PATIENT CONCERNS

A 65-year-old woman presented to the emergency department with a 3-week history of abdominal distention, anorexia, and night sweating, and a 2-week history of melena. She was a silent hepatitis B virus carrier. Abdominal ultrasound showed massive ascites without cirrhosis. Abdominal computed tomography revealed ascites, infiltrative peritoneal lesions with omental cake appearance, and lymphadenopathies.

DIAGNOSIS

We performed paracentesis and the ascites cytology was obtained. The patient also underwent esophagogastroduodenoscopy, which showed ulcerative tumors in the stomach. Both ascites cytology and pathology of the gastric tumors confirmed the diagnosis of B-cell lymphoma.

INTERVENTIONS

This patient received 7 cycles of chemotherapy.

OUTCOMES

Follow-up imaging studies revealed partial remission of lymphoma, but an enlargement of residual tumors in omentum and mesentery, which resulted in intractable ascites and rapid deterioration of performance status. Despite a change of regimen of chemotherapy, this patient expired 10 months after diagnosis.

LESSONS

Lymphoma should be one of the differential diagnoses in patients with intractable ascites not attributable to other comorbidities.

Practical Approach to Adrenal Imaging

Various pathologies can affect the adrenal gland. Noninvasive cross-sectional imaging is used for evaluating adrenal masses. Accurate diagnosis of adrenal lesions is critical, especially in cancer patients; the presence of adrenal metastasis changes prognosis and treatment. Characterization of adrenal lesions predominantly relies on morphologic and physiologic features to enable correct diagnosis and management. Key diagnostic features to differentiate benign and malignant adrenal lesions include presence/absence of intracytoplasmic lipid, fat cells, hemorrhage, calcification, or necrosis and locoregional and distant disease; enhancement pattern and washout values; and lesion size and stability. This article reviews a spectrum of adrenal pathologies.

Skeletal Muscle Involvement in B-Cell Lymphoma: Two Cases Illustrating the Contribution of Imaging to a Clinically Unsuspected Diagnosis

Skeletal muscle lymphoma is rare, comprising only a very small subset of lymphoma cases. There are characteristic imaging features which, if recognized, can prevent delay in diagnosis and treatment, particularly when not suspected clinically. Herein, we report two cases of skeletal muscle lymphoma with nearly identical imaging features; the first is an example of primary muscle lymphoma in a 17-year-old boy with back and thigh pain, and the second represents lymphoma recurrence in a 55-year-old man with HIV. Characteristic features seen on MRI were key in raising suspicion for the disease and helped prevent a delay in pathologic diagnosis.

Practical Approach to Adrenal Imaging

Various pathologies can affect the adrenal gland. Noninvasive cross-sectional imaging is used for evaluating adrenal masses. Accurate diagnosis of adrenal lesions is critical, especially in cancer patients; the presence of adrenal metastasis changes prognosis and treatment. Characterization of adrenal lesions predominantly relies on morphologic and physiologic features to enable correct diagnosis and management. Key diagnostic features to differentiate benign and malignant adrenal lesions include presence/absence of intracytoplasmic lipid, fat cells, hemorrhage, calcification, or necrosis and locoregional and distant disease; enhancement pattern and washout values; and lesion size and stability. This article reviews a spectrum of adrenal pathologies.

Lymphography and Abdominal Computed Tomography in the Staging of Non-Hodgkin Lymphoma

Ninety-one patients with non-Hodgkin lymphoma (NHL) were subjected to computed tomography (CT) and lymphography. Both examinations agreed in 74 patients (81%) with regard to the infradiaphragmatic lymph nodes. In patients undergoing CT prior to lymphography, the concordance amounted to 75 per cent. When lymphography was the initial examination, the concordance amounted to 86 per cent. Lymphography was abnormal in 30 per cent of the patients with a normal CT scan and in 93 per cent of those with an abnormal CT scan as the first examination. CT was abnormal in 4 per cent of patients with a normal lymphogram and in 84 per cent of those with an abnormal lymphogram as the first examination. CT did not detect mesenteric or retrocrural lymph node enlargement in the absence of retroperitoneal lymph node involvement. Eleven patients had extranodal manifestations of the disease (excluding liver and spleen), and 3 were detected primarily with CT. Lymphography is the most complete examination for the infradiaphragmatic lymph nodes for staging purposes. Although CT outlined the disease better, it changed the ***lymphographic diagnosis in only 2 per cent of the patients. Lymphography modified the CT stage in 15 per cent of the patients. When abdominal CT is performed first, in staging patients with NHL, lymphography will only yield additional information when CT is normal or equivocal.

CT in Pancreatic Involvement of Non-Hodgkin Lymphoma

In an attempt to evaluate characteristic CT features of primary pancreatic involvement in non-Hodgkin lymphoma (NHL), scans of 10 patients were reviewed retrospectively and compared to 50 patients with histologically proved different neoplasms of the pancreas. Setting the correct diagnosis of NHL would be essential for planning of treatment and prognosis. CT findings of NHL were characteristic but not specific. Nevertheless, the presence of a homogeneous pancreatic mass with a diameter of 7 cm or more, infiltrating surrounding tissue accompanied by retroperitoneal and/or mesenteric lymphadenopathy strongly suggests NHL. CT-guided needle biopsy can help to establish the diagnosis of pancreatic NHL.

Primary pancreatic lymphoma forming a giant mass in a short period: A case report

A 69 year old man with chief complaints of vomiting and nausea was referred to our hospital. Ultrasonographic examination on 19 May 1998 showed a hypoechoic homogeneous mass 6 cm in diameter in the head of the pancreas. Degree of intravascular infiltration was angiographically mild despite its large size. Tumor-marker levels were normal. On 9 August 1998, however, ultrasonography showed the mass to have rapidly grown (10 cm in diameter) including a heterogeneous internal structure. The mass had a linear or branching signal pattern.

Autoimmune pancreatitis: multidetector-row computed tomography (MDCT) and magnetic resonance (MR) findings in the Italian experience

Multidetector-row computed tomography (MDCT) and magnetic resonance (MR) imaging are currently the most frequently performed imaging modalities for the study of pancreatic disease. In cases of suspected autoimmune pancreatitis (AIP), a dynamic quadriphasic (precontrast, contrast-enhanced pancreatic, venous and late phases) study is recommended in both techniques. In the diffuse form of autoimmune pancreatitis (DAIP), the pancreatic parenchyma shows diffuse enlargement and appears, during the MDCT and MR contrast-enhanced pancreatic phase, diffusely hypodense and hypointense, respectively, compared to the spleen because of lymphoplasmacytic infiltration and pancreatic fibrosis. During the venous phase of MDCT and MR imaging, the parenchyma appears hyperdense and hyperintense, respectively, in comparison to the pancreatic phase. In the delayed phase of both imaging modalities, it shows retention of contrast media. A "capsule-like rim" may be recognised as a peripancreatic MDCT hyperdense and MR hypointense halo in the T2-weighted images, compared to the parenchyma. DAIP must be differentiated from non-necrotizing acute pancreatitis (NNAP) and lymphoma since both diseases show diffuse enlargement of the pancreatic parenchyma. The differential diagnosis is clinically difficult, and dynamic contrast-enhanced MDCT has an important role. In the focal form of autoimmune pancreatitis (FAIP), the parenchyma shows segmental enlargement involving the head, the body-tail or the tail, with the same contrast pattern as the diffuse form on both modalities. FAIP needs to be differentiated from pancreatic adenocarcinoma to avoid unnecessary surgical procedures, since both diseases have similar clinical and imaging presentation. The differential diagnosis is clinically difficult, and dynamic contrast-enhanced MDCT and MR imaging both have an important role. MR cholangiopancreatography helps in the differential diagnosis. Furthermore, MDCT and MR imaging can identify the extrapancreatic manifestations of AIP, most commonly biliary, renal and retroperitoneal. Finally, in all cases of uncertain diagnosis, MDCT and/or MR follow-up after short-term treatment (2-3 weeks) with high-dose steroids can identify a significant reduction in size of the pancreatic parenchyma and, in FAIP, normalisation of the calibre of the upstream main pancreatic duct.

Masticator space: imaging anatomy for diagnosis

Masticator space anatomy and pathologic conditions are illustrated examples from computed tomography and magnetic resonance imaging. Characteristic imaging features of various disease processes are presented to aid the otolaryngologist (head and neck surgeon) in diagnosis. The article describes infection, primary neoplasm, metastatic disease, Osteonecrosis, and vascular anomalies.

Bilateral adrenal lesions

Bilateral adrenal lesions include a spectrum of disorders: neoplastic disorders (metastases, lymphoma, bilateral phaeochromocytoma, adrenocortical carcinoma and myelolipoma); longstanding congenital adrenal hyperplasia and macronodular adrenal hyperplasia; infections such as tuberculosis, histoplasmosis and blastomycosis; adrenal haemorrhage; adrenals in hypoperfusion complex and paediatric masses. Bilateral distribution in addition to other imaging characteristics can help narrow differential diagnoses in case of adrenal masses. We present a pictorial review highlighting the adrenal lesions that can present bilaterally.

Metastatic disease to the pancreas: an imaging challenge

Metastatic lesions of the pancreas are uncommon, accounting for approximately 2% of pancreatic malignancies. Many tumours involve the pancreas secondarily and may manifest with different clinical and imaging characteristics. Although many patients have widespread disease, isolated metastases can be found. Surgical management is associated with improved survival in these cases. The experience of the pancreatic surgery unit and imaging department of our hospital in many patients presenting with pancreatic metastases is presented, and a review of the recent literature is undertaken. Main Messages • The early recognition of secondary pancreatic tumours on US, CT and MRI is extremely important. • Pancreatic metastases may mimic primary pancreatic adenocarcinoma or induce acute pancreatitis. • Most pancreatic metastases are discovered on a CT examination performed for follow-up.

Burkitt lymphoma with pancreatic involvement

A 10-year-old boy was referred to our clinic for tonsillectomy and was found to have a large mass within his oropharynx. Intraoperative biopsies confirmed Burkitt lymphoma. Further imaging and biopsy revealed pancreatic involvement. He was treated with multiagent chemotherapy. He remains disease-free 6 years later. Review of the literature demonstrates other cases of non-Hodgkin lymphoma with pancreatic involvement with good outcomes. Pancreatic involvement is a relatively rare occurrence in childhood lymphoma.

FDG PET/CT of extranodal involvement in non-Hodgkin lymphoma and Hodgkin disease

The term extranodal disease refers to lymphomatous infiltration of anatomic sites other than the lymph nodes. Almost any organ can be affected by lymphoma, with the most common extranodal sites of involvement being the stomach, spleen, Waldeyer ring, central nervous system, lung, bone, and skin. The prevalence of extranodal involvement in non-Hodgkin lymphoma and Hodgkin disease has increased in the past decade. The imaging characteristics of extranodal involvement can be subtle or absent at conventional computed tomography (CT). Imaging of tumor metabolism with 2-[fluorine-18]fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET) has facilitated the identification of affected extranodal sites, even when CT has demonstrated no lesions. More recently, hybrid PET/CT has become the standard imaging modality for initial staging, follow-up, and treatment response assessment in patients with lymphoma and has proved superior to CT in these settings. Certain PET/CT patterns are suggestive of extranodal disease and can help differentiate tumor from normal physiologic FDG activity, particularly in the mucosal tissues, bone marrow, and organs of the gastrointestinal tract. Familiarity with the different extranodal manifestations in various locations is critical for correct image interpretation. In addition, a knowledge of the differences in FDG avidity among the histologic subtypes of lymphoma, appropriate timing of scanning after therapeutic interventions, and use of techniques to prevent brown fat uptake are essential for providing the oncologist with accurate information.

Incidental adrenal lesions: principles, techniques, and algorithms for imaging characterization

Incidental adrenal lesions are commonly detected at computed tomography, and lesion characterization is critical, particularly in the oncologic patient. Imaging tests have been developed that can accurately differentiate these lesions by using a variety of principles and techniques, and each is discussed in turn. An imaging algorithm is provided to guide radiologists toward the appropriate test to make the correct diagnosis.

Primary omental gamma/delta T-cell lymphoma involving the central nervous system

Gamma/delta T-cell lymphoma (GDTL) is an uncommon lymphoma that was initially reported to involve only the liver and spleen. GDTL other than the hepatosplenic type is extremely rare. Frequent primary sites include skin and subcutaneous tissue, intestine, or nasal region. We report a case of GDTL of the omentum in a 54 year-old-man. The tumor cells are CD2-, CD3+, CD4-, CD5-, CD8+, CD56+, TIA-1+, granzyme B+/-. They expressed the identical phenotype of intestinal GDTL. The patient was treated with 2 courses of CHOP which comprised cyclophosphamide, doxorubicin, vincristine and prednisolone, and 3 courses of EPOCH which comprised etoposide, prednisolone, vincristine, cyclophosphamide and doxorubicin. However, he failed to obtain remission. During the fourth course of EPOCH, muscle weakness of the lower extremities developed and intracranial masses were observed by computed tomographic scan of the brain. Dissemination of lymphoma to the central nervous system was considered and it may be attributable to the expression of CD56 in this case. High dose methotrexate (HD-MTX) chemotherapy successfully eliminated the omental tumor and reduced the size of the intracranial masses, thus HD-MTX appears to be an effective treatment against GDTL.

Computerised tomography in the staging of Hodgkin's disease and non-Hodgkin's lymphoma

The last 25 years have seen major changes in the imaging investigation and subsequent management of patients with Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL); accurate staging is vital for prognostication and treatment in both, and particularly in HD. The choice of imaging modality for staging depends on its accuracy, impact on clinical decision-making, and availability. Modern CT scanners fulfil most of the desired criteria. The advent of CT scanning, along with the development of ever more effective chemotherapeutic regimens, has resulted in the virtual demise of bipedal lymphangiography (LAG) as a staging tool in patients with lymphoma. It has rendered superfluous a battery of other tests that were in routine use. This contribution reviews the evidence for the use of CT in preference to LAG. CT accurately depicts nodal enlargement above and below the diaphragm, has variable sensitivity for intra-abdominal visceral involvement and is generally outstanding in depicting the extent of disease, especially extranodal extension. Despite the advances in CT technology, there are still areas where CT performs less well (e.g. disease in normal-sized lymph nodes, splenic and bone marrow infiltration). The influence of technical factors, such as the use of intravenous contrast medium, is discussed. In some instances, CT is not the imaging modality of choice and the place of newer techniques such as MRI and endoscopic ultrasound will be reviewed.

Análise de achados de imagem e alterações clínicas em pacientes com linfoma

A tomografia computadorizada é atualmente o estudo de imagem de escolha para a detecção e estadiamento de linfomas. A tomografia computadorizada é capaz de mensurar com acurácia significativa a extensão e o volume do tumor e prover informações que possam ser usadas para planejar uma estratégia terapêutica apropriada. O presente trabalho teve como objetivo descrever e analisar os achados de imagem obtidos por meio de tomografia computadorizada de tórax e abdome, acompanhada de ultra-sonografia de abdome total de pacientes com diagnóstico de linfoma e com sorologia negativa para o vírus HIV, alterações clínicas, como a queixa que levou o paciente a procurar o serviço de saúde, já revelando sinais de acometimento da doença linfocitária, neste momento ainda não diagnosticada, e alterações ao exame físico nesta primeira consulta. A amostra estudada foi composta por 30 pacientes, sendo que, destes, 40% teriam o diagnóstico de linfoma não-Hodgkin, 46,6% de linfoma Hodgkin, 10% de linfoma de Burkitt e 3,3% com o diagnóstico de linfoma linfoblástico.

State-of-the-art adrenal imaging

The adrenal gland is a common site of disease, and detection of adrenal masses has increased with the expanding use of cross-sectional imaging. Radiology is playing a critical role in not only the detection of adrenal abnormalities but in characterizing them as benign or malignant. The purpose of the article is to illustrate and describe the appropriate radiologic work-up for diseases affecting the adrenal gland. The work-up of a suspected hyperfunctioning adrenal mass (pheochromocytoma and aldosteronoma) should start with appropriate biochemical screening tests followed by thin-collimation computed tomography (CT). If results of CT are not diagnostic, magnetic resonance (MR) and nuclear medicine imaging examinations should be performed. CT has become the study of choice to differentiate a benign adenoma from a metastasis in the oncology patient. If the attenuation of the adrenal gland is over 10 HU at nonenhanced CT, contrast material-enhanced CT should be performed and washout calculated. Over 50% washout of contrast material on a 10-minute delayed CT scan is diagnostic of an adenoma. For adrenal lesions that are indeterminate at CT in the oncology patient, chemical shift MR imaging or adrenal biopsy should be performed. Certain features can be used by the radiologist to establish a definitive diagnosis for most adrenal masses (including carcinoma, infections, and hemorrhage) based on imaging findings alone.

Palliative management of metastatic tumors involving the psoas muscle: case reports and review of the literature

Seven case reports of patients with metastatic tumors in the psoas muscle are described. Reasons for the rarity of this neoplastic disease complication are considered. The efficacy of radiotherapy in providing palliation of symptomatic patients is examined.

Primary pancreatic lymphoma: a case report, literature review, and proposal for nomenclature

Primary neoplasms of the pancreas are most often adenocarcinoma. Non-Hodgkin's lymphoma (NHL) involving the pancreas is less common but well documented; the pancreas as the primary site of NHL is rare. The majority of patients with pancreatic cancer, whether it is adenocarcinoma or lymphoma, present with a mass in the head of the gland. Pancreatic lymphoma is often described as a large homogeneous mass with extra-pancreatic extension, with or without associated lymphadenopathy. Less common presentations are masses in the body or tail, or more rarely diffuse involvement of the pancreas. We present a case of diffuse pancreatic lymphoma with extra-pancreatic dissemination to the spleen and lymph nodes, and review the literature on pancreatic lymphoma. Because the definition of pancreatic lymphoma and primary pancreatic lymphoma varies, we also propose a nomenclature system to make future studies of pancreatic lymphoma more comparable.

Gallium-67-citrate scintigraphy of primary renal lymphoma

We present a case of primary renal lymphoma, which is a rare entity and poses diagnostic challenge. Ultrasound and CT scan demonstrated a nonspecific solid tumor in the left kidney. 67Ga-citrate scintigraphy demonstrated an intense uptake in the tumor, which led to a correct diagnosis, so that we could spare unnecessary laparotomy and possible nephrectomy.

Primary muscle lymphoma

Primary muscle lymphoma is rare. Less than 50 cases have been described. The clinical and radiological features of muscle lymphoma are presented in this series of six cases. Most patients present with solitary or multiple masses which may be painful. Clinical presentation varies from the indolent to the rapidly progressive. Systemic symptoms occur in a minority. In most cases, ultrasound shows an ill-defined hypoechoic mass but apparent coarsening of fibroadipose septa and swelling of muscle bundles may occur. CT shows an iso/hypo dense mass. On MR the mass appears iso/minimally hyperintense to muscle on T1W and enhances, and hyperintense on T2W, proton density and fat suppression sequences. Infiltration of the subcutaneous fat is a striking feature in a majority of cases on CT and MR. The diagnosis can be established by ultrasound guided biopsy and should be performed urgently in HIV positive patients to exclude pyomyositis.

Lymphoma of unknown origin located in paravertebral muscles: an unusual cause of low back pain in children

The authors report a case of an adolescent with a poorly differentiated lymphoma of unknown origin located at paravertebral muscles, whose presently symptom was low back pain.

Diagnostic imaging in the evaluation of renal lymphoma

Renal lymphoma usually is a manifestation of disseminated disease and often is asymptomatic. Occasionally, the kidney(s) may be the major or only demonstrable site of disease, which may then present with a variety of urologic symptoms. The imaging studies should be tailored according to the presenting symptoms and prior history. Currently CT with intravenous contrast material enhancement is the study of choice for both the evaluation of renal involvement as well as staging of the disease. When necessary, CT or sonography may be used to guide percutaneous needle biopsy of suspicious masses. The role of the various imaging techniques, including MR and positron emission tomography, in the evaluation of renal lymphoma is discussed.

The radiology of non-Hodgkin's lymphoma in childhood: a review of 80 cases

The clinical spectrum of childhood non-Hodgkin's lymphoma (NHL) is different from that in adults, with frequent extranodal involvement. CT scanning as part of routine staging appears to show more frequent sites of extranodal disease than were previously recognized. We have reviewed the CT and other radiological findings in 80 children with NHL to document the incidence and radiological appearance of visceral involvement, to compare this with the pattern of adult disease, and to assess how frequently clinical stage of disease was altered by radiological findings. The age of the children ranged from 9 months to 17 years 4 months (mean 9 years 2 months). The presenting site was in the abdomen in 21 (27%), extranodal sites in the head and neck in 18 (23%), mediastinum in 16 (20%), peripheral lymph nodes in 15 (19%), pelvic organs in four, skin in four, and bone in two. Fifteen children had gastrointestinal lymphoma, the majority involving the ileocaecal junction. The kidneys were involved in 10 children, the pancreas in three; no child with renal or pancreatic involvement had associated retroperitoneal lymph node enlargement. Eight children had bone involvement and only two of the 80 children had pulmonary nodules at presentation. In this series, of the 44 children who had CT of the chest and abdomen, only five had stage of disease increased as a result, three with the primary disease in peripheral lymph nodes, and two with the primary disease in extranodal sites in the head and neck.

Computed tomography of diffuse, non-metastatic enlargement of the adrenal glands in patients with malignant disease

The aim of this study was to test the hypothesis that diffuse non-metastatic enlargement of the adrenal glands occurs in patients with malignant disease. Measurements of the adrenal glands were obtained from computed tomographic (CT) images in two groups of patients with malignant disease (47 patients with lymphoma and 144 patients with other primary tumours) and a control group consisting of 55 patients without malignant disease. Patients with conditions known to affect the adrenal glands were excluded. Adrenal glands with focal mass lesions, as judged by CT, were also excluded. The following measurements were obtained: the maximum width perpendicular to the long axis of the gland; and maximum width of the medial and lateral limbs. There was a statistically significant difference in all measurements between the control group and the groups with lymphoma and other tumours. No significant difference was demonstrated in the size of the adrenal glands in patients with different stages of malignancy. We have shown that the adrenal glands are enlarged in patients with malignant tumours, including lymphoma. We believe that this enlargement is due to adrenal hyperplasia rather than to metastatic neoplasm.

Isolated lymphoma of genitourinary tract and adrenals

With the routine use of computed tomographic imaging, intrinsic involvement of the genitourinary tract in newly diagnosed non-Hodgkin's lymphoma is seen in as many as 10 percent of patients. Incidental discovery of an extranodal, extra-lymphatic lesion in the genitourinary tract without clinical or radiographic evidence of disease elsewhere, however, is an uncommon occurrence. The clinical presentation and imaging findings in 4 patients with initial manifestation of lymphoma isolated to the kidney, ureter, bladder, and adrenals, respectively, are presented. These patients had no evidence of lymphoma elsewhere, and imaging studies mimicked the more common neoplasms affecting these organs.

Non-Hodgkin lymphoma of the ureter: CT demonstration with pathologic correlation

A case of a 42-year-old man with non-Hodgkin lymphoma of the ureter is reported. Diffuse lymphomatous infiltration of the ureter occurs rarely and is an uncommon cause of ureteral obstruction. Imaging-pathologic correlation is presented with CT images and autopsy specimens.

CT in adrenal enlargement due to tuberculosis: a review of literature with five new cases

Tubercular adrenalitis presents with adrenal enlargement prior to its atrophy and calcification. Imaging modalities like ultrasound, computerized tomography (CT), and magnetic resonance imaging have depicted adrenal enlargement due to various causes. Presented is a clinical-cum-CT review of 14 cases of tubercular adrenal enlargement with addition of five new cases and their CT follow-up.

CT manifestations of infectious mononucleosis

A case of infectious mononucleosis (IM) which, on computed tomography (CT) scan, mimicked the morphologic features of lymphoma is reported. The CT findings in this case include generalized lymphadenopathy, splenomegaly, and focal low-attenuation splenic lesions in a fifty-three year old woman; these findings have not previously been described in patients with IM. This is most likely because IM is usually a clinical diagnosis confirmed by serologic testing. Imaging modalities such as CT scan have not routinely been utilized to support this diagnosis.

Non-Hodgkin's lymphoma of the bladder--CT and MRI appearances

Computed tomography (CT) appearances of two patients with primary bladder non-Hodgkin's lymphoma are presented with magnetic resonance imaging (MRI) correlation in one. The differences between primary and secondary bladder lymphoma with respect to their clinical presentation, course and prognosis are described. Bladder lymphoma is a rare tumour which often presents as a large multilobular submucosal mass, and such an appearance may suggest the diagnosis. Bladder lymphoma, however, cannot be differentiated from the more common transitional cell carcinoma on the basis of CT attenuation values or enhancement patterns, or MRI signal characteristics. The diagnosis must, therefore, be made by histology. Other differential diagnoses and the role of various imaging techniques in the diagnosis and management of bladder lymphoma are considered.

[Primary bilateral, adrenal, highly malignant B-cell lymphoma with lymphoblastic mengiosis]

A 64-year-old man with high malignant B-cell lymphoma in both adrenal glands was investigated. Adrenal insufficiency was his predominant symptom at presentation. Despite surgical resection of the malignancy and cytostatic chemotherapy leptomeningeal involvement occurred and the patient died nine month after the diagnosis. Nine so far reported cases with primary adrenal lymphoma were reviewed. One of these also developed lymphomatous leptomeningitis. Suggestions of a pathogenetic contribution of adrenal lymphoma to leptomeningeal involvement and arising therapeutic consequences in the treatment of primary adrenal lymphoma are discussed.

Non-Hodgkin's lymphoma confined to the adrenal glands presenting with Addison's disease

We report an unusual case of Addison's disease which is unique in being diagnosed ante-mortem as being due to Non-Hodgkin's lymphoma of the adrenal glands. Both ante- and post-mortem examinations showed the lymphoma to be entirely confined to the adrenals.

Malignant involvement of the iliopsoas muscle: CT appearances

Computed tomography has led to an increase in recognition of psoas pathology in general and malignant involvement in particular. A series of 25 cases of malignant involvement of the iliopsoas is presented. The wide spectrum of malignant tumours which can invade the psoas and the diversity of CT appearances are described. In particular, it is shown that involvement is frequently extensive, a feature which has not been previously emphasised.

Primary adrenal lymphoma

A case of non-Hodgkin's lymphoma (large cell immunoblastic sarcoma) arising as a primary malignancy in the adrenal gland is reported and the literature concerning this unusual tumor is reviewed. Although extremely rare, it is possible to make the diagnosis preoperatively. Therefore, primary adrenal lymphoma should be included in the differential diagnosis of a suprarenal mass.

Malignant histiocytosis involving pancreas at initial presentation

A 10-year-old boy with malignant histiocytosis presented with fever, hepatosplenomegaly, and diffuse pancreatic enlargement, mimicking acute pancreatitis. Although malignant histiocytosis involving pancreas at initial presentation is exceptional, this entity should be included in the differential diagnosis of acute pancreatitis, especially when hepatosplenomegaly and pancytopenia are present.