DOI: http://dx.doi.org/10.18203/2349-2902.isj20212732

Diffuse peritoneal lymphomatosis or abdominal tuberculosis: a clinico-radiological conundrum

Abhirup H. R., Aishwarya K. C.

Abstract


Primary extra nodal lymphoma occurs in approximately 25% to 40% of patients and is more common in patients with NHL. Diffuse large B-cell lymphoma (DLBCL) is the dominant histological subtype. A 60-year-old gentleman presented to our hospital with pain abdomen associated with abdominal distension since a month, few constitutional symptoms with bilateral axillary and inguinal lymphadenopathy. Blood investigations showed high total count with significantly high LDH levels. Provisional diagnosis of tubercular Abdomen/Malignant Ascites with Unknown primary was made. CT Abdomen showed large bowel wall thickening with parietal peritoneal lesions with omental cake. Excision biopsy of inguinal lymph node showed lymphoid follicles with poorly defined attenuated mantle zones having centrocytes and centroblasts. Immunohistochemistry was positive for markers, which confirmed the diagnosis of Stage 4B DLBCL, germinal center B-cell type. Sepsis and acute kidney injury occurred and the patient expired, 6 days after diagnosis. To conclude, Peritoneal lymphomatosis is an extremely rare condition. This case highlights the need to have a high index of suspicion for malignancy, when a given case is clinically diagnosed with tuberculosis as and when new findings appear during investigation.


Keywords


Peritoneum, Non-Hodgkin Lymphoma, Tuberculosis

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References


Shital T, Anand SM, Punam J. Case report: Pediatric duodenum Burkitt’s Lymphoma. Indian J Radio Imaging. 2007;17:4.

Khaled MM, Ali T, Ali IS. Burkitt's lymphoma of the colon and bronchi: three case reports. Cases J. 2008;1:15.

Jennifer HT, Cynthia IP, Bernard IB, Stuart AR, Rathi V. Imaging of Childhood Non-Hodgkin Lymphoma assessment by Histologic Subtype. Radiograhics. 1994;14:11-28.

Cabral FC, Krajewski KM, Kim KW. Peritoneal lymphomatosis: CT and PET/CT findings and how to differentiate between carcinomatosis and sarcomatosis. Cancer Imaging. 2015;13:162-70.

Diop AD, Fontarensky M, Montoriol PF. CT imaging of peritoneal carcinomatosis and its mimics. Diagn Interv Imaging. 2014;95:861-72.

Patel YA, Muir AJ. Evaluation of new-onset ascites. JAMA. 2016;316:340-1.

Sehn LH, Berry B, Chhanabhai M. The revised International Prognostic Index (R-IPI) is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP. Blood. 2007;109:1857-61.

Horger M, Müller-Schimpfle M, Yirkin I. Extensive peritoneal and omental lymphomatosis with raised CA 125 mimicking carcinomatosis: CT and intraoperative findings. Br J Radio. 2004;77:71-3.

Lynch MA, Cho KC, Jeffrey RBJr. CT of peritoneal lymphomatosis. AJR Am J Roentgenol. 1988;151:713-5.