Duodenal lenfoma

Özet

Gastrointestinal lenfomada mide en sık tutulan bölgedir; duodenum daha seyrek tutulur ve duodenal lenfoma primer olarak ya da sistemik lenfomanın sekonder bağırsak tutulumu şeklinde görülebilir. Portal venöz faz BT, segmental duvar kalınlaşmasını, lümen şeklini, mezenterik/retroperitoneal nodları ve diğer organ tutulumunu gösterir. Tümör duvarı kalınlaştırırken lümenin daralmak yerine genişlemesi, adenokarsinoma göre ayırıcı bir ipucudur ancak lenfoma için özgül değildir. Bağırsak lenfoması lezyonları BT veya PET incelemesinde saptanmayabilir; yaygınlığın değerlendirilmesi gerektiğinde tüm bağırsakların endoskopik incelemesi gerekebilir.

Faz ve pencere

Portal tanısal

Duvar boyunca homojen, konsantrik veya nodüler kalınlaşma; belirgin hastalıkta lümen genişleyerek anevrizmatik görünebilir. Mezenterik ve retroperitoneal lenf nodları, dalak ve diğer abdominal organlar eşlik eden tutulum için incelenir.

BT bulguları

• BT’de duodenumda segmental duvar kalınlaşması veya kitle görülebilir. Endoskopide mukozal nodüller, polipoid lezyonlar ya da ülserasyon saptanabilir.
• Anevrizmatik lümen genişlemesi — duvar infiltrasyonuna rağmen lümen açık kalabilir ve genişlemiş görünebilir.
• Polipoid/eksantrik kitle — daha sınırlı duvar odağı veya komşu dokulara uzanan kitle biçiminde sunum.
• Obstrüksiyon ve kanama gibi ciddi komplikasyonlar gelişebilir; özellikle foliküler lenfomada asemptomatik seyir veya fokal stenoz yapmayan duvar tutulumu gözlenebilir.
• Mezenterik ve retroperitoneal lenfadenopati — birden çok nodal istasyonun tutulması eşlik edebilir.
• Duodenum dışındaki bağırsak segmentlerinde de lenfoma lezyonları bulunabilir; özellikle jejunum ve ileum tutulumu eşlik edebilir.
• Ülserasyon ve nekroz — agresif ya da ileri lezyonda duvar bütünlüğü ve çevre yağ planı bozulabilir.
• Duodenal lenfomanın alt tipini BT görünümü tek başına belirleyemez; kesin histolojik tanı için biyopsi örneğinin patolojik ve immünohistokimyasal değerlendirmesi gerekir.
• Duodenal lenfoma endoskopide nodüler, ülseratif veya protrüde lezyonlar şeklinde görülebilir; makroskopik görünüm alt tipe göre değişir.

Normalde

Normal duodenumda duvar ince, düzgün ve lümen kesintisizdir; çevre mezenterik ve retroperitoneal nodlar belirgin kitle görünümü oluşturmaz. D2'nin pankreas başı çevresindeki kıvrımı ve D3'ün damarlar önündeki geçişi korunur. Kıyaslarken duvar kalınlığına ek olarak lümenin daralıp daralmadığını, genişleyip genişlemediğini ve nodal dağılımın tek bölgeyle sınırlı olup olmadığını değerlendirin.

Ayırıcı tanı

Duodenal adenokarsinom

çoğunlukla kısa, düzensiz stenoz yapar ve proksimal lümeni genişletebilir.

Çocuklarda Crohn hastalığında BT'de çok segmentli bağırsak tutulumu ve mezenterik damar belirginliği görülebilir.

Duodenal GİST, duodenal kitlelerin ayırıcı tanısında yer alır; endosonografi lenfomayı diğer tümörlerden ayırmada her zaman yeterli olmayabilir.

Groove pankreatiti

pankreatikoduodenal oluk inflamasyonu ve duvar kistik değişiklikleri yapabilir; klinik pankreatit bulguları ayırıcıdır.

Metastaz

bilinen primer tümör ve başka organlarda metastatik dağılım duodenal tutulumu destekler.

Tuzaklar

• Anevrizmatik genişleme lümen patensini gösterir ancak lenfomaya özgü değildir; nodal dağılım ve diğer bağırsak segmentlerini birlikte inceleyin.
• Küçük ince bağırsak tümörleri BT'de gözden kaçabilir; klinik şüphe sürüyorsa endoskopik inceleme ve gerektiğinde doku örneklemesi tanısal değerlendirmeyi tamamlayabilir.
• Tek bir bölgesel nodu lenfoma olarak yorumlamayın; nodların dağılımı, şekli ve eşlik eden dalak/bağırsak bulguları tanısal bağlamı oluşturur.
• Anevrizmatik lümen genişlemesi lenfomayla klasik olarak ilişkilendirilse de özgül değildir; ince bağırsak melanom metastazları da nadiren bu görünümü oluşturabilir ve ayırıcı tanıda düşünülmelidir.

Kendini dene

1. Duodenumda uzun homojen duvar kalınlaşması var; lümen genişlemiş ve mezenterik nodlar eşlik ediyor. En olası tanı?

   • Duodenal lenfoma
   • Duodenal adenokarsinom
   • Duodenal GİST
   • Groove pankreatiti
   Cevabı göster

   Duodenal lenfoma. Duvar kalınlaşmasına rağmen lümenin genişlemesi ve nodal hastalık lenfomayı destekler. Adenokarsinom genellikle stenoz yapar; GİST daha sınırlı ekzofitik kitledir; groove pankreatiti oluk merkezli inflamasyondur.

2. Fokal düzensiz D2 stenozu ve yukarı akımda mide genişlemesi görülüyor. Lenfomadan daha olası lezyon?

   • Duodenal adenokarsinom
   • Duodenal lenfoma
   • Mezenterik lenfoma
   • Dalak lenfoması
   Cevabı göster

   Duodenal adenokarsinom. Fokal düzensiz stenoz ve proksimal genişleme adenokarsinom paternidir. Duodenal lenfomada kalın duvara karşın lümen açıklığı sıklıkla korunur; diğer seçenekler bu fokal obstrüktif duvar görünümünü açıklamaz.

Kaynaklar

Bu sayfadaki 41 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 12 cümle bu karşılaştırmada düzeltildi (2026-10-09).

1. Review of lymphoma in the duodenum: An update of diagnosis and managementpmc.ncbi.nlm.nih.gov
2. Diagnosing Median Arcuate Ligament Syndrome in a Patient With a History of Duodenal Lymphoma: A Case Reportpmc.ncbi.nlm.nih.gov
3. Primary duodenal papilla lymphoma producing obstructive jaundice: a case reportpmc.ncbi.nlm.nih.gov
4. Successful mucosal incision-assisted biopsy for the histological diagnosis of duodenal lymphoma: A case reportpmc.ncbi.nlm.nih.gov
5. Successful Use of a Multidisciplinary Approach to Treat a Perforated Duodenal Malignant Lymphoma in an Elderly Patientpmc.ncbi.nlm.nih.gov
6. HIV-related/AIDS cholangiopathy: pictorial review with emphasis on MRCP findings and differential diagnosis.pubmed.ncbi.nlm.nih.gov
7. Acute pancreatitis as the first manifestation of duodenal MALT lymphoma.pubmed.ncbi.nlm.nih.gov
8. Primary duodenal papilla lymphoma producing obstructive jaundice: a case report.pubmed.ncbi.nlm.nih.gov
9. Renaissance of Radiotherapy in Intestinal Lymphoma? 10-Year Efficacy and Tolerance in Multimodal Treatment of 134 Patients: Follow-up of Two German Multicenter Consecutive Prospective Phase II Trials.pubmed.ncbi.nlm.nih.gov
10. Successful Use of a Multidisciplinary Approach to Treat a Perforated Duodenal Malignant Lymphoma in an Elderly Patient.pubmed.ncbi.nlm.nih.gov
11. Primary duodenal T/histiocyte-rich large B-cell lymphoma complicated with obstructive jaundice: A case report and review of literature.pubmed.ncbi.nlm.nih.gov
12. Diagnosing Median Arcuate Ligament Syndrome in a Patient With a History of Duodenal Lymphoma: A Case Report.pubmed.ncbi.nlm.nih.gov
13. Gastrointestinal Manifestations of Immunodeficiency: Imaging Spectrum.pubmed.ncbi.nlm.nih.gov
14. Primary duodenal NK/T-cell lymphoma with massive bleeding: A case report.pubmed.ncbi.nlm.nih.gov
15. Duodenal imaging on the spotlight: from A to Z.pubmed.ncbi.nlm.nih.gov
16. Rare case of small intestine bleeding.pubmed.ncbi.nlm.nih.gov
17. Gastric marginal zone B cell lymphoma of the duodenum.pubmed.ncbi.nlm.nih.gov
18. Enteroscopic and radiologic diagnoses, treatment, and prognoses of small-bowel tumors.pubmed.ncbi.nlm.nih.gov
19. A case of nodal malignant lymphoma presenting with arterial bleeding related to its duodenal penetration.pubmed.ncbi.nlm.nih.gov
20. Clinical features of primary intestinal follicular lymphoma: A single-center retrospective study.pubmed.ncbi.nlm.nih.gov
21. Beyond the Surface: Duodenal-Type Follicular Lymphoma Diagnosed Despite Normal-Appearing Duodenal Mucosa and Absence of Focal Duodenal FDG Uptake.pubmed.ncbi.nlm.nih.gov
22. When Histology Is Unknown: Surgical Decision-Making in Small Bowel Tumors-From Preoperative Imaging to Intraoperative Findings: A Narrative Review.pubmed.ncbi.nlm.nih.gov
23. Imaging Approach to Diverticular Disease of the Small Bowel.pubmed.ncbi.nlm.nih.gov
24. Inflammatory myofibroblastic tumor in the liver after bone marrow transplantation: case report and literature review.pubmed.ncbi.nlm.nih.gov
25. Tuberculosis Beyond the Lungs: A Pictorial Review of Key Diagnostic Imaging Insights.pubmed.ncbi.nlm.nih.gov
26. The forgotten appearance of metastatic melanoma in the small bowel.pubmed.ncbi.nlm.nih.gov
27. International Harmonization of Nomenclature and Diagnostic Criteria (INHAND): Nonproliferative and Proliferative Lesions of the Rabbit.pubmed.ncbi.nlm.nih.gov
28. The role of enteroscopy in the diagnosis and interventional management of small intestine diseases.pubmed.ncbi.nlm.nih.gov
29. Small Intestine Tumors: Diagnostic Role of Multiparametric Ultrasound.pubmed.ncbi.nlm.nih.gov
30. Diagnostic clues in patients with clinical malabsorption and pathological small intestinal villous atrophy: Immune-mediated type and beyond.pubmed.ncbi.nlm.nih.gov
31. A pictorial essay on cross-sectional imaging findings of pathologies in the second (D2) segment of the duodenum in adults.pubmed.ncbi.nlm.nih.gov
32. Imaging findings of primary monomorphic epitheliotropic intestinal T-cell lymphoma: A case report.pubmed.ncbi.nlm.nih.gov
33. Unraveling the complexity of IgG4-related aortitis and periarteritis: from pathogenesis to clinical practice.pubmed.ncbi.nlm.nih.gov
34. Cavitating mesenteric lymph node syndrome: a rare complication of celiac disease-case report and literature review.pubmed.ncbi.nlm.nih.gov
35. Rare Presentation of Sequential Mucosa-Associated Lymphoid Tissue Lymphoma, Follicular Lymphoma, and Chronic Lymphocytic Leukemia: A Case-Based Review.pubmed.ncbi.nlm.nih.gov
36. 불분명한 소아 복부 종괴: 영상 기반 진단 접근법.pubmed.ncbi.nlm.nih.gov
37. Analysis of Diagnosis and Treatment of Active Lupus Enteritis Accompanied by Intestinal Pseudo-Obstruction as the Initial Manifestation: A Case Report and Literature Review.pubmed.ncbi.nlm.nih.gov
38. Stricturing Diseases of the Gastrointestinal Tract-Current Clinical Practice.pubmed.ncbi.nlm.nih.gov
39. Long-term safety and effectiveness of the "OptEase" vena cava filter.pubmed.ncbi.nlm.nih.gov
40. Aggressive Burkitt Lymphoma Mimicking Acute Pancreatitis: A Case Report.pubmed.ncbi.nlm.nih.gov
41. Diagnosis of pyogranulomatous and neutrophilic lymphadenitis in 72 cats presenting to a referral hospital: with a focus on nine cats with steroid-responsive lymphadenitis.pubmed.ncbi.nlm.nih.gov
42. Clinical characteristics and literature review of chronic active Epstein-Barr virus-associated enteritis.pubmed.ncbi.nlm.nih.gov
43. Gastrointestinal Ultrasound: Measurements and Normal Findings - What Do You Need to Know?pubmed.ncbi.nlm.nih.gov
44. Intestinal T-cell lymphoma not otherwise specified presenting with Jejunal perforation: a case report and review of the literature.pubmed.ncbi.nlm.nih.gov
45. Diffuse Large B-Cell Lymphoma Masquerading as Recurrent Pleural Effusion and Melena: A Case Report and Literature Review.pubmed.ncbi.nlm.nih.gov
46. Metastasis of cutaneous squamous cell carcinoma to the duodenum: a case report.pubmed.ncbi.nlm.nih.gov
47. A Conceptual Bi-Dimensional Risk Assessment Framework in Bleeding Peptic Ulcers.pubmed.ncbi.nlm.nih.gov
48. Rectal Metastasis from Breast Cancer: A Case Report and Review of Literature.pubmed.ncbi.nlm.nih.gov
49. Vascular anatomy of the right colon: A cadaveric study in a Vietnamese population with surgical implications.pubmed.ncbi.nlm.nih.gov
50. Imaging diagnosis and sequential conservative treatment of pediatric traumatic duodenal intraluminal hematoma.pubmed.ncbi.nlm.nih.gov
51. Usefulness of an intraoperative flipped monitor in laparoscopic surgery with situs inversus totalis: a case report of laparoscopic-assisted ileocecal resection.pubmed.ncbi.nlm.nih.gov
52. Imaging Characteristics of Pylorogastric, Duodenogastric, and True-Gastrogastric Intussusception in 25 Dogs and One Cat.pubmed.ncbi.nlm.nih.gov
53. Spectrum of bowel wall thickening on ultrasound with pathological correlation in children.pubmed.ncbi.nlm.nih.gov
54. Initial Abdominal CT and Laboratory Findings Prior to Diagnosis of Crohn's Disease in Children.pubmed.ncbi.nlm.nih.gov
55. Crohn's disease at radiological imaging: focus on techniques and intestinal tract.pubmed.ncbi.nlm.nih.gov
56. Malignant Small Bowel Neoplasms: A 20-Year Retrospective Analysis in a Tertiary Center.pubmed.ncbi.nlm.nih.gov
57. Acute gastrointestinal hemorrhage as the sole initial manifestation of gastric leiomyosarcoma: a case report highlighting the discrepancy between preoperative assessment and final pathology.pubmed.ncbi.nlm.nih.gov
58. A case of groove pancreatic carcinoma presenting with rapidly progressive ascending colon stenosis: a rare case report.pubmed.ncbi.nlm.nih.gov
59. Groove pancreatitis, diagnosis, and management strategies: a case series.pubmed.ncbi.nlm.nih.gov
60. Etiology, diagnosis, and management of chronic pancreatitis associated primary complications: a narrative review.pubmed.ncbi.nlm.nih.gov
61. Case Report: Resectability-guided management of an indeterminate periduodenal spindle cell tumor initially suspected to be a gastrointestinal stromal tumor.pubmed.ncbi.nlm.nih.gov
62. Brunner's gland hamartoma in the setting of a duodenal diverticulum: A case report.pubmed.ncbi.nlm.nih.gov
63. Primary pancreatic squamous cell carcinoma with duodenal invasion: Literature review and a case report.pubmed.ncbi.nlm.nih.gov
64. Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.pubmed.ncbi.nlm.nih.gov
65. Glossary of terms for musculoskeletal radiology.pubmed.ncbi.nlm.nih.gov
66. Missed lesions at CT colonography: lessons learned.pubmed.ncbi.nlm.nih.gov
67. Does gadolinium-based contrast material improve diagnostic accuracy of local invasion in rectal cancer MRI? A multireader study.pubmed.ncbi.nlm.nih.gov
68. Ileal tuberculosis presenting with severe unexplained anemia and unusual pseudo-tumoral imaging features: A case report.pubmed.ncbi.nlm.nih.gov
69. Application of robotic-assisted hepatopancreatoduodenectomy in non-jaundiced gallbladder cancer patient with invasion of the common bile duct: A case report.pubmed.ncbi.nlm.nih.gov
70. First Brazilian expert consensus for video capsule endoscopy and balloon-assisted enteroscopy.pubmed.ncbi.nlm.nih.gov
71. Role of Endoscopy in Malignant Biliary Obstruction.pubmed.ncbi.nlm.nih.gov
72. Robotic-assisted total gastrectomy for refractory hypoproteinemia in Menetrier's disease: a case report with operative video and literature review.pubmed.ncbi.nlm.nih.gov
73. Commentary: an eye on PET quantification.pubmed.ncbi.nlm.nih.gov
74. In vitro expanded human CD4+CD25+ regulatory T cells suppress effector T cell proliferation.pubmed.ncbi.nlm.nih.gov
75. Synchronous Low-Grade Alimentary Lymphoma and Gastrointestinal Mast Cell Tumor with a Collision Pattern in a Cat.pubmed.ncbi.nlm.nih.gov
76. Short colon syndrome in cats.pubmed.ncbi.nlm.nih.gov
77. The hidden path of mycobacterium: a case series of rare and elusive manifestations of gastrointestinal tuberculosis.pubmed.ncbi.nlm.nih.gov
78. Hypereosinophilic syndrome mimicking gastric malignancy: considerations on the challenging diagnosis-a case report and review of the literature.pubmed.ncbi.nlm.nih.gov
79. Multiple Incidental Pancreatic Neuroendocrine Tumors in a Patient With Suspected Duodenal Papillary Adenocarcinoma: A Case Report.pubmed.ncbi.nlm.nih.gov
80. International Union of Basic and Clinical Pharmacology. CX. Classification of Receptors for 5-hydroxytryptamine; Pharmacology and Function.pubmed.ncbi.nlm.nih.gov
81. Case Report: pulmonary MALT lymphoma with <i>BIRC3::MALT1</i> fusion and indeterminate PET/CT findings.pubmed.ncbi.nlm.nih.gov
82. Unilateral Orbital Lymphomas: A Structured Multidisciplinary Workflow for Diagnosis and Management.pubmed.ncbi.nlm.nih.gov
83. Dural Lymphomas Unmasked: A Narrative Review of Extra-Axial Mimics and a Pragmatic Diagnostic Decision Algorithm.pubmed.ncbi.nlm.nih.gov
84. Musculoskeletal Manifestations of T-Cell Lymphomas: Clinical Presentation, Imaging Features, Pathobiology, and Orthopedic Considerations-A Narrative Review.pubmed.ncbi.nlm.nih.gov
85. Rare case report and literature review of peripheral T-cell lymphoma presenting as massive gastrointestinal hemorrhage: an unusual etiology demanding emergency surgical intervention.pubmed.ncbi.nlm.nih.gov
86. Clinical Spectrum and Therapeutic Options in Monogenic CTLA-4-, LRBA-, or SOCS1-Related Primary Immune Regulatory Disorders.pubmed.ncbi.nlm.nih.gov
87. Emergency ultrasonography of the gastrointestinal tract of children.pubmed.ncbi.nlm.nih.gov
88. Marrow to Bowel or Bowel to Marrow: Intestinal Myeloid Sarcoma Presenting With Acute Obstruction.pubmed.ncbi.nlm.nih.gov
89. Small and Large Intestine (I): Malabsorption of Nutrients.pubmed.ncbi.nlm.nih.gov
90. Computed tomography features of a primary extragastrointestinal stromal tumor of the lesser omentum with spontaneous calcification in a young adult: A case report.pubmed.ncbi.nlm.nih.gov
91. Preoperative Computed Tomography Colonography-Angiography for Vascular Mapping to Guide and Standardize D3 Lymphadenectomy in Right-Sided and Transverse Colon Cancer.pubmed.ncbi.nlm.nih.gov
92. Complete mesocolic excision and central vascular ligation for right colon cancer: an introduction for abdominal radiologists.pubmed.ncbi.nlm.nih.gov
93. Desmoid-Type Fibromatosis of the Proximal Jejunum Mimicking Gastric Gastrointestinal Stromal Tumor: Diagnostic Pitfalls in Determining the Tumor Origin.pubmed.ncbi.nlm.nih.gov
94. A primary retroperitoneal anaplastic lymphoma kinase-positive anaplastic large cell lymphoma with tumor thrombosis.pubmed.ncbi.nlm.nih.gov
95. Epidemiological and clinical trends of malignant small-bowel tumors in Asia.pubmed.ncbi.nlm.nih.gov
96. Eosinophilic Duodenitis and Jejunitis with Ascites and Peripheral Eosinophilia: A Diagnostic Challenge-Case Report.pubmed.ncbi.nlm.nih.gov
97. Surgery and diagnostic imaging in abdominal Crohn's disease.pubmed.ncbi.nlm.nih.gov
98. A novel clustering of down syndrome and coeliac disease complicated by enteritis and small intestinal strictures: a case series.pubmed.ncbi.nlm.nih.gov
99. The Many Faces of Intestinal Tumors in Adults, Including the Primary Role of CT Imaging in Emergencies and the Important Role of Cross-Sectional Imaging: A Pictorial Review.pubmed.ncbi.nlm.nih.gov
100. Duodenal tuberculosis with probable biliary involvement in primary Sjögren's syndrome mimicking pancreatobiliary malignancy: a case report.pubmed.ncbi.nlm.nih.gov
101. Clinical indications and outcomes of pediatric gastrointestinal endoscopy in a resource-limited healthcare system: Findings from the first multicenter study.pubmed.ncbi.nlm.nih.gov
102. Endoscopic findings are associated with histologic types of primary small intestinal lymphoma: a retrospective study in Japan.pubmed.ncbi.nlm.nih.gov
103. Unusual Ampullary Presentation of Pediatric Burkitt Lymphoma: Case Report and Literature Review.pubmed.ncbi.nlm.nih.gov
104. Duodenal leiomyoma: a case report of upper gastrointestinal hemorrhage from a giant duodenal tumor.pubmed.ncbi.nlm.nih.gov

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