Malignancy #1

Lymphoma, Leukemia and Look-a-like Lesions Abdominal Imaging Manifestations of Hematologic Malignancies and their Mimickers

Andrew Kesselman, Anju Dubey, Jason Gonsky, Patrick Hammill

Purpose

1. To highlight the abdominal imaging characteristics of

Leukemia and lymphoma in solid and hollow viscous

organs

2. Review specific cases with emphasis on major teaching

points

3. Demonstrate unique conditions which may mimic

Leukemia and lymphoma

#1 – Chronic Myelogenous Leukemia vs.

Sarcoidosis

References:

1. Leite NP, Kased N, Hanna RF et al. Cross-sectional Imaging of Extranodal

Involvement in Abdomino-pelvic Lymphoproliferative Malignancies.

Radiographics 2007; 27:1613-1634.

2. Lee WK, Lau EW, Duddalwar VA, Stanley AJ, Ho YY. Abdominal

Manifestations of Extranodal Lymphoma: Spectrum of Imaging Findings. AJR

2008; 191:198-206.

#2 – Adult T cell Leukemia/Lymphoma

vs. Hepatic Candidiasis

#3 – Diffuse B cell Lymphoma vs.

Typhlitis

Bonus PET image demonstrates

diffuse abnormal bowel, peritoneal,

and nodal FDG-18 uptake

#4 – Hodgkin’s Lymphoma vs.

Castleman’s Disease

#5 – Peri-renal Lymphoma vs. Peri-renal

Hematoma

Bonus contrast enhanced CT image

demonstrates diffuse adenopathy in a

patient with follicular T cell lymphoma

Multiple hypodense lesions

within the splenic parenchyma

Differential Diagnosis:

Metastatic disease,

Pneumocystis carinii,

Histoplasmosis, Kaposi

sarcoma, Tuberculosis

Multiple hypodense lesions

throughout the hepatic

parenchyma

Differential Diagnosis:

Metastatic disease, Multifocal

abscesses, Kaposi sarcoma,

Sarcoidosis

Small bowel wall thickening is

noted on these images

Differential Diagnosis:

Inflammatory bowel disease,

Bowel wall hemorrhage, Enteritis,

Amyloidosis

Images demonstrate diffuse

abdominal lymphadenopathy

Differential diagnosis:

Metastatic disease, Tuberculosis,

Nontuberculous mycobacterial

infection, mesenteric adenitis

Amorphous high density

surrounding the left kidney

Differential Diagnosis:

Hemorrhagic: Angiomyolipoma,

metastatic disease, renal cell

carcinoma, Post-traumatic

Background/Epidemiology

Leukemia, lymphoma, and other hematologic

malignancies together accounted for about 9.4% of cancer

related deaths in 2012, with an even higher percentage in

children.

Extranodal involvement more common in

immunosuppressed patients and suggests advanced

disease.

Imaging Characteristics

• GI Tract: Gastric > Small Bowel > Colon > Esophagus

• Liver and Spleen: Usually results in nonspecific

organomegaly but can cause uni- or multifocal masses

• Kidney/adrenals: Multifocal pattern most common

• Lymph node enlargement most common yet nonspecific

Main Teaching Points

1. Abdominal leukemia and lymphoma are a

heterogeneous group of hematologic malignancies of

lymphoid or myeloid origin with both nodal and extranodal

clinical and radiological manifestations.

2. Lymph node enlargement is the most common finding,

although the most non-specific sign of abdominal

involvement. Extranodal involvement can be seen

throughout the solid and hollow viscous organs with

classic and sometimes bizarre imaging appearances.

3.Various mimicking lesions mirror the radiologic

characteristics of abdominal lymphoma and leukemia

ranging from other malignancies, tuberculosis,

opportunistic infections, sarcoidosis and benign

lymphoproliferative disorders.

Mimicker #1

Mimicker #2

Mimicker #3

Mimicker #4

Mimicker #5

Malignancy #2

Malignancy #3

Malignancy #4

Malignancy #5

Bonus non-contrast CT image

demonstrates multiple destructive

lytic lesions of ATLL

Bonus axial T2 weighted MR image

demonstrates diffuse gastric and

gallbladder wall thickening from

diffuse B cell lymphoma

Bonus contrast enhanced CT image

demonstrates tuberculous

involvement of the spleen