NonHodgkin's Lymphoma with Peritoneal Localization

Abstract

The gastrointestinal tract is the most common extranodal site involved with lymphoma accounting for 5-20% of all cases. Lymphoma can occur at any site of the body, but diffuse and extensive involvement of the peritoneal cavity is unusual and rare. We report a case of diffuse large B-cell lymphoma in a 57-year-old female infiltrating the peritoneum and omentum and presenting with ascites and pleural effusion. The performed examinations did not discover any pathological findings affecting the digestive tract or parenchymal organs, except for diffuse thickening of the peritoneum and omentum. Peripheral, mediastinal, or retroperitoneal lymphadenopathy was not registered. The blood count revealed only elevated leukocytes and on examination there were no immature blood cells in the peripheral blood. The cytology from the ascites and pleural effusion did not detect any malignant cells. Due to the rapid disease progression the patient died after twenty-two days of admission. The diagnosis was discovered postmortem with the histological examination and immunohistochemical study of the material taken during the surgical laparoscopy performed four days before the lethal outcome. Although cytology is diagnostic in most cases, laparoscopy with peritoneal biopsy is the only procedure which can establish the definitive diagnosis of peritoneal lymphomatosis.

Figure 1

A 57-year-old woman with diffuse large B-cell lymphoma and peritoneal lymphomatosis chest radiography shows right-sided pleural effusion without mediastinal enlargement or other significant abnormalities.

Figure 2

Abdominal ultrasound shows ascites without findings of liver cirrhosis or portal hypertension.

Figure 3

Thoracic ultrasound shows effusion in the right pleural space.

Figure 4

Histological features from peritoneal and omental biopsies. H&E stain: (a) diffuse infiltration of neoplastic lymphoid cells (400x). (b) Tumor cells immunoreactive for B cell marker CD 20 (200x). (c) Tumor cells expressing high Ki-67 index (100x).