Mesenteric lymphoma is a cancer that affects white blood cells called B lymphocytes, or B cells. B cells work as part of the immune system and help the body fight infection. Mesenteric lymphoma is a rare disease, affecting fewer than 1 out of every 200,000 people.
The tissue between the intestine and the abdominal wall that envelopes the bowel is called the mesentery. Mesenteric lymphoma forms in the lymph nodes within the mesentery.
Lymphoma is divided into two main categories, Hodgkin lymphoma and non-Hodgkin lymphoma (NHL). Mesenteric lymphoma is typically non-Hodgkin lymphoma. Specifically, it is usually a subtype of NHL that forms in B cells, called follicular lymphoma. Some cases are also diffuse large B-cell lymphomas.
Signs and symptoms are both indicators of conditions. Symptoms are what a person personally experiences, such as a headache or nausea. Signs are what a doctor can observe or measure, such as a fever or high blood pressure. Abdominal pain is the most common symptom of mesenteric lymphoma, caused by the tumor in the abdomen. In rare cases, a person might also have thrombocytopenia (low levels of platelets in the blood) or dermatitis herpetiformis (a condition that causes itchy skin lesions). Some people with mesenteric lymphoma may not experience any symptoms.
Signs and symptoms that occur with other forms of lymphoma, such as weight loss, may also occur with mesenteric lymphoma.
Different medical tests can help a doctor diagnose mesenteric lymphoma.
CT scans, as well as scans using positron emission tomography (PET) combined with CT (PET-CT), are technologies used to image tissues in the body. A CT scan or PET-CT scan can identify an abdominal mass as well as enlarged lymph nodes (lymphadenopathy) or other internal lesions (tumors) caused by mesenteric lymphoma. The primary mass in the mesentery often has a unique appearance referred to as a “sandwich sign” since it resembles a hamburger on the CT scan.
A lymph node biopsy may also be important for diagnosis. In this procedure, a lymph node is surgically removed from the mesentery and examined under a microscope for cancer cells.
Blood tests can measure blood cell counts and levels of the lactate dehydrogenase (LDH) protein, which may both be affected by lymphoma.
Following diagnosis, the main treatment option for mesenteric lymphoma is surgery to remove the mass, followed by chemotherapy. Chemotherapy may be administered as a single drug, such as bendamustine (Treanda), or as a combination of different drugs. The treatment regimen known as EPOCH has been used to treat mesenteric lymphoma. EPOCH is a combination of:
Chemotherapy is usually given together with a drug called rituximab (Rituxan). Rituximab is an antibody that recognizes a molecule called CD20 on the surface of B cells so it can target the cancer specifically.
Mesenteric lymphoma is extremely rare, so much of the knowledge around the disease comes from case reports that follow just a single person. As a result, it is difficult to estimate a prognosis (outlook) or survival rate. Some cases indicate that the cancer responds well to chemotherapy. However, it is also possible for the cancer to come back (relapse) after treatment. A person with mesenteric lymphoma should attend follow-up appointments with a doctor to monitor the status of the disease. Additional research needs to be done in order to better understand this rare cancer and identify effective treatments.
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