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Peritoneal lymphomatosis shown on positron emission tomography/computed tomography scanning

A 4-year-old girl presented with ileocaecal intussusception that failed air enema reduction. During surgery, an ileocaecal mass was found to have caused the intussusception and ileocecal resection with ileo–ascending colon anastomosis was performed. Histology showed Burkitt lymphoma. Staging F-fluorodeoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT) scanning (Biograph mCT 64-slice, Siemens AG, Erlangen, Germany) showed diffusely increased metabolic activity in the peritoneum involving the greater and lesser omentum, mesentery, paracolic gutters and pouch of Douglas, consistent with extensive lymphomatous involvement. On a maximum intensity projection (MIP) image (left), the abdomen and pelvis appeared as if smeared with ink with the hypermetabolic areas not conforming to any anatomical structure. The MIP image also showed a hypermetabolic rim around the liver extending over the liver dome. These findings were indicative of peritoneal lymphomatosis. The patient was treated with chemotherapy and after completion of this, F-FDG PET/ CT showed complete metabolic resolution of peritoneal lymphomatosis (right). Peritoneal lymphomatosis is rare as compared to peritoneal carcinomatosis. Among the lymphoma subtypes, Burkitt lymphoma is an uncommon cause. Although about 20% of patients with non-Hodgkin lymphoma show serosal or omental involvement at autopsy, extensive peritoneal involvement by lymphoma, as in this patient, is unusual. Early recognition and treatment is essential because peritoneal lymphomatosis can result in abdominal compartment syndrome, especially if severe and untreated. In contrast to peritoneal carcinomatosis, peritoneal lymphomatosis may be cured without surgery. This case illustrates the usefulness of F-FDG PET/CT in demonstrating this rare entity and assessing its response to treatment.