Journal of Radiology
Open Access

Abdominal Lymphoma; Radiology; Hodgkin lymphoma; Magnetic resonance imaging

Introduction

Types of abdominal lymphoma

Abdominal lymphomas are broadly classified into two main categories: Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). NHL comprises a diverse group of lymphomas, including diffuse large B-cell lymphoma (DLBCL), follicular lymphoma, and mantle cell lymphoma, among others. Each of these subtypes has distinctive clinical and imaging features that guide their identification and management [1].

Imaging techniques

Several imaging techniques are employed in the evaluation of abdominal lymphoma. These include:

Computed tomography (CT): CT scans are widely used due to their ability to provide detailed cross-sectional images of abdominal structures. In lymphoma, CT helps visualize enlarged lymph nodes, organ involvement, and any associated complications. It aids in determining the disease stage, assessing response to treatment, and detecting relapse. Contrast-enhanced CT is particularly valuable in highlighting vascular and tissue changes indicative of lymphoma.

Magnetic resonance imaging (MRI): MRI offers excellent soft tissue contrast and is particularly useful in evaluating organ involvement and delineating structures in the abdominal region. It is especially valuable in cases where the differentiation between lymphoma and other abdominal masses is challenging. MRI is often used to assess the extent of disease and to guide biopsies [ 2].

Positron emission tomography-computed tomography (PETCT):PET-CT combines functional information from PET scans (which detect metabolic activity) with anatomical details from CT scans. This hybrid imaging technique is highly sensitive in detecting areas of abnormal metabolic activity, which can help identify active disease sites, assess treatment response, and detect residual disease after treatment completion.

Ultrasound: Ultrasound is commonly used for initial evaluation due to its safety, cost-effectiveness, and real-time imaging capabilities. It can aid in the detection and assessment of lymph node enlargement, as well as the presence of solid or cystic masses in various abdominal organs.

Literature Review

Staging and treatment response assessment

Accurate staging is essential in determining the appropriate treatment strategy for abdominal lymphoma patients. Imaging plays a key role in this process, helping to classify the disease into different stages based on the extent of its spread. This information guides decisions on whether to initiate chemotherapy, radiation therapy, targeted therapies, or a combination of these treatments [3].

Furthermore, imaging is crucial in assessing the response to treatment. Repeat imaging scans allow clinicians to monitor changes in the size and metabolic activity of lymph nodes and affected organs. This information helps modify treatment plans, identify treatment-resistant cases, and guide decisions about further interventions, such as stem cell transplantation.

Challenges and future directions

While imaging techniques have significantly advanced our ability to diagnose and manage abdominal lymphoma, certain challenges persist. Distinguishing lymphoma from other malignancies or benign conditions can be complex due to overlapping features. Additionally, the heterogeneity of lymphoma subtypes requires tailored imaging approaches [4].

Future directions in imaging for abdominal lymphoma may involve the integration of newer technologies, such as radiomics and artificial intelligence. Radiomics involves extracting quantitative features from medical images to aid in diagnosis and treatment planning. AI algorithms can assist radiologists in analyzing complex imaging data, improving accuracy, and aiding in early disease detection [5].

Clinical presentation

The clinical presentation of abdominal lymphoma can vary depending on the specific subtype, the extent of organ involvement, and the stage of the disease. Common symptoms include abdominal pain, bloating, nausea, vomiting, weight loss, and changes in bowel habits. Enlarged lymph nodes in the abdomen might be palpable during physical examination [6]. However, the symptoms can be nonspecific, resembling other gastrointestinal disorders, which can make diagnosis challenging.

Discussion

Staging systems

Staging systems are used to classify the extent of disease in abdominal lymphoma and guide treatment decisions. The Ann Arbor staging system is commonly used for lymphomas and is based on the extent of lymph node involvement and the presence of disease in extranodal sites. It classifies lymphomas into stages I to IV, with substages indicating the involvement of certain organs.

For Hodgkin lymphoma, the Cotswolds modification of the Ann Arbor staging system adds the presence or absence of specific symptoms, such as fever, night sweats, and weight loss, collectively known as “B symptoms.” These symptoms can provide additional prognostic information [7].

Treatment approaches

The treatment approach for abdominal lymphoma depends on various factors including the type of lymphoma, stage, patient’s overall health, and other individual considerations. Common treatments include:

Chemotherapy: Chemotherapy is a cornerstone of treatment for many types of abdominal lymphomas. It involves the use of powerful drugs to kill or slow the growth of cancer cells. Combination chemotherapy regimens are often used to target different aspects of the disease [8].

Radiation therapy: Radiation therapy focuses high-energy beams on specific areas affected by cancer. It’s commonly used in earlystage disease or to target specific sites with residual disease after chemotherapy.

Targeted therapies: Some lymphomas have specific molecular targets that can be exploited with targeted therapies. These therapies are designed to interfere with specific molecules involved in the growth and survival of cancer cells.

Stem cell transplantation: For patients with certain aggressive lymphomas or relapsed disease, stem cell transplantation might be considered. It involves replacing damaged bone marrow with healthy stem cells, usually after high-dose chemotherapy or radiation.

Immunotherapy: Immunotherapy, such as monoclonal antibodies, can be used to enhance the body’s immune response against lymphoma cells.

Prognosis

The prognosis for abdominal lymphoma varies widely based on factors such as the subtype of lymphoma, stage at diagnosis, treatment response, and individual patient characteristics. Some lymphomas, like certain types of indolent (slow-growing) non-Hodgkin lymphomas, can have a more favorable prognosis, while aggressive lymphomas may require more intensive treatment and can have a variable outcome [9].

Follow-up and surveillance

After treatment, regular follow-up and surveillance are essential to monitor for disease recurrence or progression. Imaging techniques, such as CT scans or PET-CT, are often used during follow-up appointments to assess treatment response and detect any residual or recurrent disease.

Conclusion

Abdominal lymphoma is a complex and diverse group of malignancies that require careful diagnosis, staging, and treatment planning. Advances in imaging technology, along with evolving treatment approaches, have significantly improved our ability to manage this condition and enhance patient outcomes. However, multidisciplinary collaboration between oncologists, radiologists, and other medical professionals remains crucial for providing optimal care to individuals with abdominal lymphoma.

Acknowledgement

None

Conflict of Interest

None

1. Anis M, Irshad A (2008) Imaging of abdominal lymphoma. Radiol Clin North Am 46: 265-285.

Indexed at, Google Scholar, Crossref

2. Shao H, Yang Zg, Deng W, Chen J, Tang SS, et al. (2012) Tuberculosis versus lymphoma in the abdominal lymph nodes: a comparative study using contrast-enhanced MRI. Eur J Radiol 81: 2513-2517.

Indexed at, Google Scholar, Crossref

3. Lenga L, Czwikla R, Wichmann JL, Leithner D, Albrecht MH, et al. Dual-energy CT in patients with abdominal malignant lymphoma: impact of noise-optimised virtual monoenergetic imaging on objective and subjective image quality. Clin Radiol 73: 833.e19-833.e27.

Indexed at, Google Scholar, Crossref

4. Satishchandra H, Sridhar AS, Pooja BP (2013) Imaging of Burkitt's lymphoma-abdominal manifestations. J Cancer Res Ther 9: 128-130.

Indexed at, Google Scholar, Crossref

5. G Jung, W Heindel, M von Bergwelt-Baildon, H Bredenfeld, A Gossmann, et al. (2000) Abdominal lymphoma staging: is MR imaging with T2-weighted turbo-spin-echo sequence a diagnostic alternative to contrast-enhanced spiral CT?. J Comput Assist Tomogr 24: 783-787.

Indexed at, Google Scholar, Crossref

6. Ri-Sheng Yu, Wei-Min Zhang, Yi-Qing Liu (2006) CT diagnosis of 52 patients with lymphoma in abdominal lymph nodes. World J Gastroenterol 12: 7869-7873.

Indexed at, Google Scholar, Crossref

7. Jing BS (1990) Diagnostic imaging of abdominal and pelvic lymph nodes in lymphoma. Radiol Clin North Am 28: 801-831.

Indexed at, Google Scholar, Crossref

8. Lee WK, Lau EWF, Duddalwar VA, Stanley AJ, Ho YY (2008) Abdominal manifestations of extranodal lymphoma: spectrum of imaging findings. AJR Am J Roentgeno 191: 198-206.

Indexed at, Google Scholar, Crossref

9. Karadeli E, Erbay G, Parlakgumus A, Yabanoglu H (2017) Abdominal CT Findings in Patients with Primary Lymphoma Causing Small Bowel Obstruction J Coll Physicians Surg Pak 27: 711-713.

Indexed at, Google Scholar