Lymphoma: Small Bowel Lymphoma

Lymphoma of the Small Bowel

• Primary gastrointestinal lymphoma arises in the small bowel, with limited mesenteric lymph node involvement, normal white blood cell count, and no peripheral or mediastinal lymphadenopathy or splenomegaly.
• Small bowel lymphomas occur predominantly in the ileum.
• Peak incidence is in the fifth decade of life.
• Susceptible patients include those with Crohn’s disease, coeliac disease, and immunosuppressive diseases such as AIDS.
• Common presentations include abdominal mass, obstruction, perforation, intussusception, hemorrhage, and malabsorption.
• Chemotherapy is the primary treatment, unless there are surgical complications.

Carcinoid Tumor

• Carcinoid tumors occur throughout the gastrointestinal tract, most commonly in the appendix, ileum, and rectum.
• The primary tumor is usually small, but liver metastases are common, leading to the carcinoid syndrome.
• The tumor produces vasoactive peptides, including 5-hydroxytryptamine (serotonin).
• Clinical syndrome characteristics include:
  • Flushing (90%) with attacks of cyanosis and chronic red-faced appearance
  • Diarrhea (70%) with noisy borborygmi
  • Bronchospasm (asthmatic attacks)
  • Abdominal pain (due to mesenteric fibrosis and partial obstruction)
  • Hepatomegaly and palpable abdominal mass
  • Sometimes pulmonary and tricuspid stenosis
• Treatment involves surgical resection in early cases, and symptomatic relief with synthetic somatostatin analogue, sandostatin, being the most effective therapy.

This quiz covers the characteristics and manifestations of lymphoma in the small bowel, including primary gastrointestinal tumors and generalized lymphomatous disease.