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CT Findings in Peripheral T-Cell Lymphoma Involving the Gastrointestinal Tract¹

¹ From the Departments of Radiology (J.H.B., H.K.H., A.Y.K., T.K.K., E.Y.K., J.K.L.), Pathology (E.S.Y.), and Internal Medicine (S.J.M., S.K.Y., H.Y.J., J.H.K.), Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, Korea. Received January 4, 2002; revision requested March 4; revision received June 3; accepted July 25. Address correspondence to H.K.H. (e-mail: hkha@amc.seoul.kr).

View larger version (138K): [in a new window]   Figure 1. Transverse contrast-enhanced CT scan obtained at the level of prepyloric antrum of the stomach in a 65-year-old woman depicts PTCL (unspecified type) involving the stomach. Scan shows moderate gastric wall thickening (arrows) with poor contrast enhancement. There is no lymphadenopathy in the perigastric region or at other sites. Also noted is mild splenomegaly (*).

View larger version (129K): [in a new window]   Figure 2a. Transverse contrast-enhanced CT scans obtained in a 44-year-old man depict PTCL (intestinal type with enteropathy) involving both the stomach and the jejunum. (a) Scan obtained at the level of gastric cardia shows poorly enhanced polypoid lesion (arrows) in the region of gastric cardia. (b) Scan obtained at a lower level shows another poorly enhanced polypoid lesion (arrows) in the jejunum. (c) Scan obtained caudal to b shows a poorly enhanced polypoid lesion (black arrows) in the jejunum and nonbulky lymphadenopathy (white arrows) along the mesentery.

View larger version (126K): [in a new window]   Figure 2b. Transverse contrast-enhanced CT scans obtained in a 44-year-old man depict PTCL (intestinal type with enteropathy) involving both the stomach and the jejunum. (a) Scan obtained at the level of gastric cardia shows poorly enhanced polypoid lesion (arrows) in the region of gastric cardia. (b) Scan obtained at a lower level shows another poorly enhanced polypoid lesion (arrows) in the jejunum. (c) Scan obtained caudal to b shows a poorly enhanced polypoid lesion (black arrows) in the jejunum and nonbulky lymphadenopathy (white arrows) along the mesentery.

View larger version (121K): [in a new window]   Figure 2c. Transverse contrast-enhanced CT scans obtained in a 44-year-old man depict PTCL (intestinal type with enteropathy) involving both the stomach and the jejunum. (a) Scan obtained at the level of gastric cardia shows poorly enhanced polypoid lesion (arrows) in the region of gastric cardia. (b) Scan obtained at a lower level shows another poorly enhanced polypoid lesion (arrows) in the jejunum. (c) Scan obtained caudal to b shows a poorly enhanced polypoid lesion (black arrows) in the jejunum and nonbulky lymphadenopathy (white arrows) along the mesentery.

View larger version (120K): [in a new window]   Figure 3. Transverse contrast-enhanced CT scan obtained at the level of the third portion of the duodenum in a 22-year-old man depicts PTCL (unspecified type) involving the duodenum. Scan shows poorly enhanced, circumferential bowel wall thickening (*) involving the third portion of the duodenum along with aneurysmal dilatation of the lumen. Also noted is bulky lymphadenopathy (M) along the mesentery, as well as minimal lymphadenopathy in the paraaortic space.

View larger version (127K): [in a new window]   Figure 4a. Images obtained in a 60-year-old man depict PTCL (intestinal type without enteropathy) involving the ileum. (a) Transverse contrast-enhanced CT scan obtained at the level of the porta hepatis shows a branching lucent pattern of intrahepatic portal vein gas with focal areas of hypoattenuating lesions (arrows) in the hepatic and splenic parenchyma caused by multifocal infarction. Also noted is pneumoperitoneum (*). (b) Transverse contrast-enhanced CT scan obtained at a lower level shows intramural gas (white arrows) in the ileal wall. There is evidence of diffuse, nonbulky lymphadenopathy (black arrows) in the mesentery, as well as in the retroperitoneum. (c) Gross surgical specimen obtained after segmental resection of the ileum shows ill-defined masses (solid arrows) and mucosal ulcerations (open arrows) in the ileum along with perforation (arrowheads). (d) Photomicrograph shows that the intestinal wall is thickened with transmural lymphoid cell infiltration. Submucosal blood vessels are destroyed with granulomatous reaction (arrows). Air-filled spaces (P) are present adjacent to the destroyed blood vessels. (Hematoxylin-eosin stain; original magnification, x20.)

View larger version (116K): [in a new window]   Figure 4b. Images obtained in a 60-year-old man depict PTCL (intestinal type without enteropathy) involving the ileum. (a) Transverse contrast-enhanced CT scan obtained at the level of the porta hepatis shows a branching lucent pattern of intrahepatic portal vein gas with focal areas of hypoattenuating lesions (arrows) in the hepatic and splenic parenchyma caused by multifocal infarction. Also noted is pneumoperitoneum (*). (b) Transverse contrast-enhanced CT scan obtained at a lower level shows intramural gas (white arrows) in the ileal wall. There is evidence of diffuse, nonbulky lymphadenopathy (black arrows) in the mesentery, as well as in the retroperitoneum. (c) Gross surgical specimen obtained after segmental resection of the ileum shows ill-defined masses (solid arrows) and mucosal ulcerations (open arrows) in the ileum along with perforation (arrowheads). (d) Photomicrograph shows that the intestinal wall is thickened with transmural lymphoid cell infiltration. Submucosal blood vessels are destroyed with granulomatous reaction (arrows). Air-filled spaces (P) are present adjacent to the destroyed blood vessels. (Hematoxylin-eosin stain; original magnification, x20.)

View larger version (190K): [in a new window]   Figure 4c. Images obtained in a 60-year-old man depict PTCL (intestinal type without enteropathy) involving the ileum. (a) Transverse contrast-enhanced CT scan obtained at the level of the porta hepatis shows a branching lucent pattern of intrahepatic portal vein gas with focal areas of hypoattenuating lesions (arrows) in the hepatic and splenic parenchyma caused by multifocal infarction. Also noted is pneumoperitoneum (*). (b) Transverse contrast-enhanced CT scan obtained at a lower level shows intramural gas (white arrows) in the ileal wall. There is evidence of diffuse, nonbulky lymphadenopathy (black arrows) in the mesentery, as well as in the retroperitoneum. (c) Gross surgical specimen obtained after segmental resection of the ileum shows ill-defined masses (solid arrows) and mucosal ulcerations (open arrows) in the ileum along with perforation (arrowheads). (d) Photomicrograph shows that the intestinal wall is thickened with transmural lymphoid cell infiltration. Submucosal blood vessels are destroyed with granulomatous reaction (arrows). Air-filled spaces (P) are present adjacent to the destroyed blood vessels. (Hematoxylin-eosin stain; original magnification, x20.)

View larger version (155K): [in a new window]   Figure 4d. Images obtained in a 60-year-old man depict PTCL (intestinal type without enteropathy) involving the ileum. (a) Transverse contrast-enhanced CT scan obtained at the level of the porta hepatis shows a branching lucent pattern of intrahepatic portal vein gas with focal areas of hypoattenuating lesions (arrows) in the hepatic and splenic parenchyma caused by multifocal infarction. Also noted is pneumoperitoneum (*). (b) Transverse contrast-enhanced CT scan obtained at a lower level shows intramural gas (white arrows) in the ileal wall. There is evidence of diffuse, nonbulky lymphadenopathy (black arrows) in the mesentery, as well as in the retroperitoneum. (c) Gross surgical specimen obtained after segmental resection of the ileum shows ill-defined masses (solid arrows) and mucosal ulcerations (open arrows) in the ileum along with perforation (arrowheads). (d) Photomicrograph shows that the intestinal wall is thickened with transmural lymphoid cell infiltration. Submucosal blood vessels are destroyed with granulomatous reaction (arrows). Air-filled spaces (P) are present adjacent to the destroyed blood vessels. (Hematoxylin-eosin stain; original magnification, x20.)

View larger version (136K): [in a new window]   Figure 5a. Transverse contrast-enhanced CT scans obtained in a 31-year-old man depict PTCL (angiocentric type) involving the sigmoid colon. (a) Scan obtained at the level of the gastroesophageal junction shows pneumoperitoneum (*) and ascites (A) in the peritoneal cavity along with hepatosplenomegaly. (b) Scan obtained at the level of pelvic cavity shows mild circumferential wall thickening of the sigmoid colon (*) along with a diffusely dilated, fluid-filled ileal loop (I) and ascites (A) in the peritoneal cavity.

View larger version (120K): [in a new window]   Figure 5b. Transverse contrast-enhanced CT scans obtained in a 31-year-old man depict PTCL (angiocentric type) involving the sigmoid colon. (a) Scan obtained at the level of the gastroesophageal junction shows pneumoperitoneum (*) and ascites (A) in the peritoneal cavity along with hepatosplenomegaly. (b) Scan obtained at the level of pelvic cavity shows mild circumferential wall thickening of the sigmoid colon (*) along with a diffusely dilated, fluid-filled ileal loop (I) and ascites (A) in the peritoneal cavity.