CASE 10642 Published on 14.02.2013

Peritoneal Lymphomatosis (Burkitt Lymphoma)

Section

Abdominal imaging

Case Type

Clinical Cases

Authors

Cláudia Paulino; Henrique Rodrigues; Maria José Julião; Filipe Caseiro-Alves

Hospitais da Universidade de Coimbra,
Serviço de Imagiologia;
Rua Egas Moniz nº22 2ºesq post
3030-329 Coimbra, Portugal;
Email:claudia_paulino@hotmail.com
Patient

37 years, male

Categories
Area of Interest Abdomen ; Imaging Technique CT, Percutaneous
Clinical History
37-year-old man with known HIV infection for the past three years presented with constitutional symptoms and abdominal distention for 15 days. An upper abdominal MDCT with intravenous contrast injection was performed.
Imaging Findings
CT shows peritoneal thickening (Fig. 1a), diffuse omental infiltration (Figs. 1b and 1c), a “stellate” appearance of the mesentery (Fig. 1c) and ascites in the pelvic cavity (Fig. 1d).
Discussion
Demonstration of diffuse infiltration of the peritoneum, omentum, or mesentery on CT, may be seen in a variety of conditions, including diffuse peritoneal tumours and infectious peritonitis [1]. Distinction between diffuse peritoneal tumours, such as carcinomatosis, lymphomatosis, malignant mesothelioma, and tuberculous peritonitis may be difficult due to the absence of specific symptoms and overlapping imaging features [2].

Lymphomas may involve the peritoneum as a primary or secondary process. Peritoneal lymphomatosis is characterized by ascites, thickened peritoneal surfaces with multifocal nodules and masses, and infiltration of mesentery and omentum [3]. In secondary involvement of the peritoneum, the presence of extensive adenopathy may suggest the diagnosis. Primary lymphomas of the peritoneum are uncommon and nearly exclusively found in immunocompromised patients as it happened in the present case.

Burkitt lymphoma is a poorly differentiated type of non-Hodgkin lymphoma derived from B-lymphocyte. The most recent World Health Organization classification divides Burkitt lymphoma into three different clinical forms, which differ in geographic distribution and Epstein-Barr virus (EBV) association: endemic, sporadic and associated with immunodeficiency. The endemic type is seen in African children and generally involves the bones of the jaw and other facial bones, whereas the sporadic type is seen in Europe and the United States and typically occurs as peripheral lymphadenopathy or intra-abdominal mass. Neoplastic cells of Burkitt lymphoma are infected by EBV in 95% of cases in endemic form, 20% in the sporadic form, and 30-40% in the form associated with HIV. Burkitt lymphomas make up the largest group of HIV‐associated non‐Hodgkin lymphomas, comprising up to 35–50% of these neoplasms in some studies [4]. There is a tendency for the lymphoma to involve extranodal sites, some of which are only rarely involved in HIV-negative patients, such as the peritoneum.

A diagnosis of Burkitt lymphoma requires a medium‐sized CD10‐positive B‐cell population with a high proliferative rate (Fig. 2) and demonstration of a translocation involving the MYC gene.
Differential Diagnosis List
Peritoneal Lymphomatosis (Burkitt Lymphoma)
Malignant peritoneal mesothelioma
Tuberculous peritonitis
Peritoneal carcinomatosis
Final Diagnosis
Peritoneal Lymphomatosis (Burkitt Lymphoma)
Case information
URL: https://www.eurorad.org/case/10642
DOI: 10.1594/EURORAD/CASE.10642
ISSN: 1563-4086