22882              DIFFUSE LYMPHOMA OF THE BOWEL

The patient was a women aged 69.  Hodgkin’s disease had been proven by biopsy of a gland in the neck 7 years previously.  Local radiotherapy was given.  On her last admission there was vague abdominal pain.  Barium meal was inconclusive but lymphangiogram suggested involvement of pelvic lymph nodes.  Three months later the abdominal pain, vomiting and bowel symptoms were worse and a central abdominal mass could be felt.  Barium meal now showed involvement of small intestine was found.  She died of pulmonary embolism 3 days later.  At postmortem there was diffuse lymphoma involving the bowel, spleen, liver and lymph nodes.

The specimen consists of some 40 cms of small bowel together with a large portion of the mesentery.  There is marked diffuse lymphomatous infiltration of the bowel to produce a long coiled rigid cylindrical tube.  The mucosal aspect of this infiltrated region is nodular but not inflamed or obviously ulcerated.  Small nodular mucosal infiltrates are visible on the right side of the specimen and there is massive infiltration in mesentery.  Histology shows a diffuse lymphoma consisting of sheets of polygonal reticulum cells which are laying down fine intercellular argyrophilic fibres.  Lymphocytes are scanty.  Reed-Sternberg giant cells are present occasionally.