IS Case 169: Lymphoma - diffuse large B cell

Sam McCabe, MD

Imaging Sciences URMC 2008
Publication Date: 2009-05-21


Patient is an 77-year-old man with dysphagia.


A middle mediastinal mass surrounds and invades the esophagus.


Lymphoma - diffuse large B cell


Although the GI tract is the most common extranodal site of primary non-Hodgkin's lymphoma (NHL), primary esophageal involvement is rare (1% of GI tract lymphomas). Patients typically have known generalized disease before esophageal spread is discovered. The esophagus is usually involved by direct spread from the stomach (the most common site of GI lymphoma) or mediastinal lymph nodes. Bulky mediastinal lymphadenopathy may result in symptomatic esophageal compression, or direct invasion, as seen here. The radiographic features of primary esophageal carcinoma, metastasis, and lymphomatous esophageal disease show considerable overlap. Esophageal metastases are most often due to direct extension from gastric, lung, thyroid, or laryngeal carcinoma. Hematogenous spread to the esophagus can be seen with breast cancer and melanoma.

The 2001 WHO classification system divides lymphoma into 4 broad categories: B Cell, T cell/Natural Killer Cell, Hodgkin's disease, and Immunodeficiency-associated lymphoproliferative disease. Diffuse large B cell lymphoma is a common, aggressive subtype, accounting for 40% of NHL in adults. Treatment typically consists of chemotherapy and steroids, with radiation for focal disease. Follicular B cell lymphoma, accounting for 30% of B cell lymphomas, typically has an indolent course.


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