GI Radiography
Case 13 :
A 25-year-old male presented with pain in the abdomen, weight loss of 5 kg in one month & malena since 20 days. Laboratory Investigations showed anemia & blood in stools. An ultrasound of the abdomen and a Barium follow-through study was performed.
What is the diagnosis?

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U.S.G. showed two masses - above the urinary bladder & in the left hypochondriac region. Both masses were hypo echoic & show central echogenicity with ring-down gas artifact (suggestive of gas). Barium study showed mucosal irregularity with dilated ileum and mass lesion. Similar lesion was seen in the proximal jejunum (pic not shown).
Diagnosis of Lymphoma was suggested. 
Excision biopsy of left inguinal node was performed. 

Conclusion of Excision Biopsy

Diffuse non-Hodgkin's poorly differentiated lymphoblastic lymphoma, non-Burkitt type (Grade II ).

Discussion 

Lymphoblastic lymphoma often arises in young men, showing high rates around the 16-year and 40-year age groups. In women, there is a more even distribution of disease across all ages. Lymphoblastic lymphoma has several clinical hallmarks, including the production of a mediastinal (middle chest) mass, involvement of the bone marrow and central nervous system (CNS), and "leukemia-like" characteristics similar to adult T-cell leukemia/ lymphoma (T-ALL). But lymph node disease (lymphadenopathy) prevails in lymphomblastic lymphoma, whereas peripheral blood changes prevail in T-ALL. Lymphatic involvement usually occurs above the diaphragm, affecting the nodes of the neck, collarbone, or underarms.
In the past, lymphoblastic lymphoma was associated with a poor prognosis; however, complete remission and long-term survival now can be accomplished with the use of intensive chemotherapy programs 

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 Dr. Ravi Kadasne, UAE