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home - Small Bowel - Small Bowel Masses - Lymphoma Written by Dr Sebastian Zeki

Lymphoma

Occurs in developing countries only.It pesents in young adulthood.It it possibly caused by infectious agent.Tetracycline can induce remission if caught early.Anthracycline is also a treatment option.It has a poor prognosis. Treatment:Laparotomy and en bloc resection of the mesentery.5yr survival is about 25%.Role of adjuvant therapy is unclear. Written by Dr Sebastian Zeki Common sites for Primary SB Lymphoma:Stomach — 75 %.Small bowel (including duodenum) — 9 % .Ileocecal region — 7 % .More than one GI site — 6 % .Rectum — 2 % .Diffuse colonic involvement — 1 % . Predisposing disorders to primary gastrointestinal lymphoma:Helicobacter pylori infection.b)Immunodeficiency syndromes and immunosuppression.Autoimmune diseases, probably due to immunosuppression.Rheumatoid arthritis.Systemic lupus erythematosus.Sjögren's syndrome.Wegener's granulomatosis.Posttransplantation immunosuppression, especially OKT3.Acquired immunodeficiency syndrome (AIDS) .Congenital immunodeficiency syndromes.Wiskott-Aldrich syndrome .Severe combined immunodeficiency syndrome.Ataxia-telangiectasia.X-linked agammaglobulinemia.Coeliac disease.Inflammatory bowel disease.Ulcerative colitis .Crohn's disease.Nodular lymphoid hyperplasia. Called Primary Small Bowel Lymphoma Occur in the Western elderly males (60% M)5y survival about 50% if resectable (with post-op chemotherapy) 4) Follicular lymphoma NB: Causes of Multiple polyps in the Small Bowel Lymphoid (nodular lymphoid hyperplasia) Hamartomas (Peutz-Jeghers) Adenomatous (Conchite-Canada Syndrome). Can be annular ulcerating multiple or diffuse Resection of transmural lymphoma can reduce risk of perforation when chemotherapy started 5yr survival 25% Presentations:Pain.Weight loss.Ulceration.Perforation in 25%. More common in ileum (more lymphoid follicles 70 % > 5 cm in diameter at presenta-tion. Primary GI tract lymphoma Non-Hodgkin's gastric lymphoma TreatmentH. pylori eradicationSingle agent chemotherapy or radiotherapyIf advanced, or diffuse large B-cell....CVP or CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone), with rituximab EATLnon-EATL 5)T-cell lymphoma 3)Burkitt’s and Burkitt-like lymphomas 2)Mantle cell lymphoma (usually colon and small bowel) Diffuse large B-cell lymphoma (high grade MALT) IPSID- Features: 1)Extranodal marginal zone B-Cell (MALT) Criteria for Diagnosis of Primary Small Bowel Lymphoma: No LN. No HS megaly. Normal leucocyte count. Lymphoma mainly in GI tract.

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