Radiol Oncol 2002; 36(1): 1-4. 

Primary non-Hodgkin lymphoma of the cecum: 
A case report 


Mateja Kropivnik, Breda Jamar, Bojana Černelč 

Clinical Institute of Radiology, University Medical Centre, Ljubljana, Slovenia 

Background. Primary lymphoma of the colon is rare, constituting 0.4 % of primary colonic malignancies 
and usually involves cecum or rectum. The aim of this paper is to present the role and the importance of double 
contrast barium enema (DCBE) in the diagnostic process. 
Case report. A 77 years old male was admitted because of suspected inflammation in the area of total endoprosthesis 
of the left hip, inserted ten years before. Listeria monocytogenes was isolated from the aspirate 
and the patient treated with antibiotics. Twenty years ago the patient underwent nephrectomy because of 
hypernephroma of left kidney. At the time of admission he had sideropenic anaemia and he was febrile. 
Conclusion. The patient underwent many diagnostic procedures: ultrasound (US), computed tomography 
(CT), double contrast barium enema, which showed a tumour in the cecum, small bowel follow-through and 
scintigraphy. The diagnosis of primary non-Hodgkin lymphoma was established by histology after biopsy 
at colonoscopy. 

Key words: cecal neoplasms – radiography; contrast media; barium; lymphoma, non-hodgkin 

Introduction 

Malignant lymphomas involve the gastrointestinal 
tract either as primary neoplasms or as 
part of disseminated disease. Primary lymphoma 
of the colon is rare, constituting 0.4 % of all 
colonic malignancies. Non-Hodgkin lymphoma 
accounts for almost all colonic lympho-

Received 28 February 2002 
Accepted 6 March 2002 

Correspondence to: Prim. Breda Jamar, M.D., Clinical 
Institute of Radiology, University Medical Centre, Ljubljana, 
Slovenia; Phone: +386 1 522-34-14; e-mail: breda.
jamar@kclj.si 

mas.1-3 The signs and symptoms of colonic 
lymphoma are non-specific. The lack of specific 
symptoms can be the reason for delayed diagnosis.
4 The most common presentation is 
abdominal pain, with weight loss and changing 
bowel habits in 60-90 % of patients.1,5 

A palpable abdominal mass can sometimes 
be noted on the initial physical examination.
6 

Double-contrast barium enema (DCBE) 
shows the changes in the large bowel, caused 
by lymphoma, but there is a broad spectrum 
of radiological variations: lymphoma is a great 
mimicker.7 

Ultrasound (US) is often the first imaging 
modality used in patients with vague abdomi



Koprivnik M et al. / Primary non-Hodgkin lymphoma of the cecum 

nal symptoms and can detect several patterns 
of involvement in cases of lymphoma.8 

Computerised tomography (CT) is invaluable 
for the staging of the disease and is an essential 
complementary study to barium examination. 
It establishes the extent and shape 
of a lymphoma, demonstrates nodal involvement 
and possible infiltration of the liver or 
spleen.9 

In our case, however, the location, the size 
and the appearance were determined by 
DCBE. 

Case report 

A 77 years old male was admitted to the hospital 
at the beginning of August 2001, because 
of pain in the left hip and high body temperature. 
Ten years ago he had a total 
endoprosthesis of the left hip inserted and 
septic coxitis was suspected. He had had a 
hypernephroma of the left kidney, treated by 
nephrectomy, 20 year prior to admission. He 
was also complaining of vague lower abdominal 
pain, weakness and a short episode of diarrhoea. 


On the admission his body temperature 
was 38.3 °C, he had sideropenic anaemia (E 
3.25, Hb 189, and Fe 4.7) and his SR was 131. 
There was no palpable peripheral lymph nodes 
enlargement, abdominal mass or enlargement 
of liver or spleen. 

The patient was treated by antibiotics, a 
needle aspiration of left hip was done and an 
orthopaedic surgeon was consulted. Scintigraphy 
showed a slightly higher activity in 
the area of left hip and in the right lower quadrant 
of the abdomen. 

Listeria monocytogenes was isolated from 
the aspirate, antibiotics therapy was changed 
and an underlying disease was suspected. 

US showed enlarged mesenterial and retroperitoneal 
lymph nodes and a bizarre, 
hyperaemic formation at the lower pole of the 
right kidney (Figure 1). CT showed normal li-

Radiol Oncol 2002; 36(1): 1-4. 

Figure 1. Ultrasound: a solid, hyperemic tumour in 
right lower quadrant of abdomen. 


Figure 2. Computerised tomography: a slight mural 
thickening in the area of ileocecal valve. 

ver parenchyma, slightly enlarged spleen, enlarged 
mesenterial and retroperitoneal lymphatic 
nodes, enlarged right kidney with parapelvic 
cysts, but no mass in the abdomen 
was described (Figure 2). Repeated US on the 
same day suggested that the tumour was in 
the area of distal segments of ileum. 

At the beginning of September a double 
contrast barium enema was performed, 
which showed an approximately 4 × 4 cm large, 
lobulated, well defined tumour in the area 
of ileocecal valve (Figure 3). The tumour did 
not have characteristics of colon carcinoma. 
A small bowel follow- through was normal. 

At colonoscopy an ulcerated, cauliflower 
mass was found in the cecum and biopsy was 
performed. 


Koprivnik M et al. / Primary non-Hodgkin lymphoma of the cecum 

Figure 3. Double contrast barium enema: a well defi-
ned lobulated tumour in the cecum. 


The histopathologic diagnosis was non-
Hodgkin, B-cell lymphoma. 

Discussion 

Colon is a rare site of gastrointestinal non-
Hodgkin lymphoma. Radiologic examination 
of large bowel and colonoscopy with biopsy 
are sufficient for definitive diagnosis, but US 
and/or CT are invaluable for the staging of 
the disease.10 

Colonic lymphoma has a variety of different 
presentations, which are best seen by the 
use of double contrast barium enema technique.
11 The radiologic changes can be divided 
into five groups: mucosal nodularity, endoexoenteric 
mass, intraluminal mass, mural infiltration 
and mesenteric invasion.3 Intraluminal 
mass is the predominant feature, often 
lobulated and ranging in size up to 20 cm, 
mostly situated in the cecum, causing irregular 
enlargement of the ileocecal valve. 

In our case the tumour, as seen on double 
contrast barium enema, met the criteria of colonic 
lymphoma as described in literature and 
it clearly did not have radiological characteristics 
of colonic carcinoma. At US, enlargement 
of lymph nodes was found and the tumour 
was seen, but its location and nature 
were not defined. 

CT is invaluable for the staging in cases of 
primary colonic lymphomas, for definition of 
tumour invasion and spread. CT findings of 
intestinal tumour can throw a suspicion of 
lymphoma. Cecal tumours which are fairly 
demarcated from the surrounding pericolonic 
fat and show no evidence of invasion or obstruction 
of neighbouring viscera are suggestive 
of lymphoma.12 In our case lymphoma 
of cecum was not obvious on CT examination. 
Because of US findings, which suggested pathology 
of the right kidney, the colon was not 
cleansed and there were a lot of faecal residua 
in the lumen, which made the proper evaluation 
of colonic disease difficult. Also, the tumour 
was small, only 4 cm in diameter. Nevertheless, 
on retrograde evaluation, the area 
of ileocecal valve showed mural thickening. 

Conclusion 

In the era of many imaging modalities, double 
contrast barium enema remains one of very 
sensitive, if not specific, diagnostic tools. The 
exact location and size can be determined 
and differential diagnoses suggested, even 
before the definitive diagnosis with biopsy is 
established. 

Radiol Oncol 2002; 36(1): 1-4. 


Koprivnik M et al. / Primary non-Hodgkin lymphoma of the cecum 

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