Mesenteric lymphoma is a lymphoproliferative disease involving mesenteric lymph nodes or mesenteric tissue, encompassing both Hodgkin and non-Hodgkin lymphoma (NHL) forms. The mesentery is one of the most common sites of involvement in abdominal lymphoma; more than 50% of NHL cases have mesenteric lymph node involvement. Aggressive NHL subtypes (diffuse large B-cell lymphoma, Burkitt) more frequently form larger mesenteric masses. The most characteristic finding on CT is the 'sandwich sign,' where enlarged lymph nodes encase mesenteric vessels. Large conglomerate lymph node masses may show a 'mantle clock pattern.' Treatment is with chemotherapy ± radiotherapy, and mesenteric lymph node involvement has prognostic significance in the Ann Arbor staging system.
Age Range
30-75
Peak Age
55
Gender
Male predominant
Prevalence
Uncommon
Mesenteric lymphoma arises from monoclonal proliferation of lymphocytes, and mesenteric lymph nodes are one of the sites of this clonal expansion. In NHL, malignant lymphocytes disrupt lymph node architecture leading to progressive growth and nodal conglomeration. The homogeneous cellular structure of tumor cells forms the basis of homogeneous soft tissue density and homogeneous enhancement on CT — necrosis is generally not seen before treatment because lymphoma cells grow within well-vascularized stroma. Enlarged lymph nodes encase mesenteric vessels (SMA, SMV branches) without invasion, creating the 'sandwich sign' — lymphoma shows perivascular growth rather than vessel wall invasion. This differs from the vessel invasion and thrombosis pattern of carcinomatous metastases. FDG uptake on PET-CT is due to increased glycolysis (Warburg effect) of lymphoma cells and is very high especially in aggressive subtypes. Shrinkage of mesenteric lymph nodes after treatment is one of the most important indicators of treatment response.
Enlarged mesenteric lymph nodes encasing SMA and SMV branches, creating a 'sandwich'-like appearance with vessels between lymph node masses. Vessels remain patent without thrombosis. This finding is highly specific for mesenteric lymphoma and reflects the perivascular growth pattern of lymphoma.
In the portal venous phase, enlarged mesenteric lymph nodes encase SMA and SMV branches, creating the characteristic 'sandwich sign.' Lymph nodes show homogeneous soft tissue density and homogeneous moderate enhancement. Vessels remain patent without thrombosis — this reflects the perivascular growth pattern of lymphoma. The sandwich sign is highly specific for mesenteric lymphoma.
Report Sentence
Conglomerate lymphadenopathy with homogeneous enhancement in sandwich configuration encasing SMA/SMV branches is seen at the mesenteric root; consistent with mesenteric lymphoma.
Multiple enlarged (>1.5 cm short axis) mesenteric lymph nodes showing homogeneous soft tissue density and homogeneous moderate enhancement. Necrosis is generally absent before treatment. Conglomerate masses may reach 'bulky disease' level (>10 cm). Retroperitoneal, pelvic, and para-aortic lymph nodes also frequently accompany.
Report Sentence
Multiple enlarged, homogeneously enhancing, conglomerate lymph nodes are seen at the mesenteric root and jejunal/ileal mesentery; lymphadenopathy consistent with lymphoma is present.
Mesenteric lymph nodes show intense FDG uptake on PET-CT. SUVmax is usually >10 in aggressive NHL subtypes. PET-CT is the gold standard imaging modality in Ann Arbor staging, treatment response assessment (Deauville score), and detection of residual disease/recurrence. Demonstration of mesenteric involvement on PET-CT is of critical importance in treatment planning.
Report Sentence
Intense FDG uptake is seen in mesenteric lymph nodes (SUVmax: ...); metabolic activity consistent with lymphoma is present.
Mesenteric lymph nodes show marked diffusion restriction on DWI with low ADC values (<0.7 × 10⁻³ mm²/s). This finding reflects the high cellularity of lymphoma. DWI is particularly valuable as a radiation-free staging tool in patients where CT is contraindicated (renal failure, contrast allergy) and in children.
Report Sentence
Mesenteric lymph nodes show marked diffusion restriction on DWI (ADC: ... × 10⁻³ mm²/s); this finding consistent with high cellularity is compatible with lymphoma.
On US, multiple hypoechoic, round, enlarged lymph nodes with loss of hilum within the mesentery. Conglomerate masses are seen as hypoechoic masses in the abdomen. Doppler shows peripheral or mixed vascularity pattern instead of hilar vascularity — a finding of malignant morphology. Posterior acoustic enhancement may be seen.
Report Sentence
Multiple hypoechoic, round, enlarged lymph nodes with loss of hilum are seen within the mesentery; consistent with lymphomatous lymphadenopathy.
On non-contrast CT, multiple enlarged, soft tissue density (30-50 HU), homogeneous lymph nodes within the mesentery. Calcification is very rare before treatment — post-treatment calcification may be seen. Necrosis and cystic degeneration are generally absent (rarely seen in large Burkitt masses).
Report Sentence
Non-contrast CT shows multiple enlarged, homogeneous soft tissue density lymph nodes within the mesentery; no calcification or necrosis is present.
Criteria
Most common aggressive NHL subtype. Forms rapidly growing, large mesenteric masses. Intense FDG uptake (SUVmax >10). Good response to chemotherapy (R-CHOP). Treatment response assessed by PET-CT (Deauville).
Distinct Features
Large conglomerate mass, prominent sandwich sign, homogeneous enhancement, necrosis rare before treatment.
Criteria
Indolent NHL subtype. Slowly growing, multiple small to moderate sized lymph nodes. Mesenteric involvement common. Variable FDG uptake (SUVmax 3-15). Watch-and-wait or rituximab-based treatment.
Distinct Features
Multiple small to moderate nodes, smaller masses compared to DLBCL, slow progression, risk of transformation.
Criteria
Very aggressive NHL subtype. Very rapidly growing (doubling time 24-48 hours) large mesenteric masses. Common in children. Necrosis may be seen. Requires intensive chemotherapy.
Distinct Features
Very large mass, rapid growth, may have necrosis areas, ileocecal region preference in children, very intense FDG uptake.
Distinguishing Feature
Carcinomatous mesenteric metastasis may cause vessel invasion/occlusion, shows heterodense nodular implants with primary tumor history; lymphoma is homogeneous, does not cause vessel occlusion and shows sandwich sign.
Distinguishing Feature
TB lymphadenitis shows central necrosis (rim enhancement) and may contain calcification; lymphoma enhances homogeneously and necrosis/calcification is generally absent.
Distinguishing Feature
Sclerosing mesenteritis shows hazy mesenteric fat density (misty mesentery) and fat ring sign; lymphoma shows discrete enlarged lymph nodes and sandwich sign.
Distinguishing Feature
Desmoid tumor is a single, solid, T2 heterogeneous mass with heterogeneous enhancement; lymphoma presents as multiple lymph nodes and shows more homogeneous T2 signal.
Urgency
urgentManagement
medicalBiopsy
NeededFollow-up
3-monthMesenteric lymphoma is a condition requiring urgent hematological evaluation and biopsy. Diagnostic biopsy is necessary for histological subtype determination — CT-guided percutaneous core biopsy or laparoscopic biopsy is preferred. Treatment is with chemotherapy ± radiotherapy according to lymphoma subtype. Ann Arbor staging and PET-CT (Deauville score) are used for treatment planning and response assessment. Follow-up with CT or PET-CT every 3-6 months is recommended after treatment.
Mesenteric lymphoma usually indicates advanced-stage NHL. PET-CT is most valuable for staging and treatment response. Excisional biopsy is needed for subtyping. Generally responds well to chemotherapy.