Arab Journal of Gastroenterology 15 (2014) 157–158
Contents lists available at ScienceDirect
Arab Journal of Gastroenterology journal homepage: www.elsevier.com/locate/ajg
Images in Gastroenterology
The sandwich sign in mesenteric lymphoma Tatsuji Maeshiro a, Akira Hokama b,⇑, Tetsu Kinjo b, Kazuto Kishimoto a, Jiro Fujita a a b
Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus, Okinawa, Japan Department of Endoscopy, University of the Ryukyus, Okinawa, Japan
a r t i c l e
i n f o
Article history: Received 29 May 2014 Accepted 30 July 2014
a b s t r a c t
Ó 2014 Arab Journal of Gastroenterology. Published by Elsevier B.V. All rights reserved.
A 74-year-old woman presented with epigastric discomfort for 2 weeks of duration. Physical examination was unremarkable. Upper endoscopy and colonoscopy were negative. Computed tomography (CT) scans disclosed two mesenteric tumours, encasing the superior mesenteric artery within the left hemiabdomen, consistent with the sandwich sign (Fig. 1). Mesenteric vessels traverse the tumour without distortion (Fig. 2). She underwent laparoscopic biopsy, which confirmed follicular medium-sized cell
type, B-cell lymphoma. She has been managed conservatively and the lymphoma has not grown for 6 years. The sandwich sign is the cross-sectional imaging appearance of mesenteric vascular trunk and fat as the sandwich filling and the bulky soft-tissue tumours as the two halves of a sandwich bun [1]. It may present ‘thunder in the cloud’ sign on the coronal reconstruction CT images [2]. Mesenteric lymphoma has characteristic features of bulky growth with enveloping mesenteric vessels, fat, and bowel but rarely causing perforation [1]. This sign is specific to mesenteric lymphoma and can be used in differentiating between tuberculous lymphadenopathy and mesenteric lymphoma [3].
Fig. 1. CT scan showing two mesenteric tumours, encasing the superior mesenteric artery (arrow) within the left hemiabdomen, consistent with the sandwich sign.
⇑ Corresponding author. Address: Department of Endoscopy, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan. Tel.: +81 98 895 1144; fax: +81 98 895 1414. E-mail address: [email protected] (A. Hokama).
Fig. 2. Three dimensional CT scan showing mesenteric vessels traverse the tumour (arrow) without distortion.
http://dx.doi.org/10.1016/j.ajg.2014.07.001 1687-1979/Ó 2014 Arab Journal of Gastroenterology. Published by Elsevier B.V. All rights reserved.
158
T. Maeshiro et al. / Arab Journal of Gastroenterology 15 (2014) 157–158
Financial disclosures None. Conflict of interest The authors declared that there was no conflict of interest.
References [1] Hardy SM. The sandwich sign. Radiology 2003;226:651–2. [2] Hokama A, Nakamoto M, Kinjo F, et al. ‘The sandwich sign’ of mesenteric lymphoma. Eur J Haematol 2006;77:363–4. [3] Dong P, Wang B, Sun QY, et al. Tuberculosis versus non-Hodgkin’s lymphomas involving small bowel mesentery: evaluation with contrast-enhanced computed tomography. World J Gastroenterol 2008;14:3914–8.
Contents lists available at ScienceDirect
Arab Journal of Gastroenterology journal homepage: www.elsevier.com/locate/ajg
Images in Gastroenterology
The sandwich sign in mesenteric lymphoma Tatsuji Maeshiro a, Akira Hokama b,⇑, Tetsu Kinjo b, Kazuto Kishimoto a, Jiro Fujita a a b
Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus, Okinawa, Japan Department of Endoscopy, University of the Ryukyus, Okinawa, Japan
a r t i c l e
i n f o
Article history: Received 29 May 2014 Accepted 30 July 2014
a b s t r a c t
Ó 2014 Arab Journal of Gastroenterology. Published by Elsevier B.V. All rights reserved.
A 74-year-old woman presented with epigastric discomfort for 2 weeks of duration. Physical examination was unremarkable. Upper endoscopy and colonoscopy were negative. Computed tomography (CT) scans disclosed two mesenteric tumours, encasing the superior mesenteric artery within the left hemiabdomen, consistent with the sandwich sign (Fig. 1). Mesenteric vessels traverse the tumour without distortion (Fig. 2). She underwent laparoscopic biopsy, which confirmed follicular medium-sized cell
type, B-cell lymphoma. She has been managed conservatively and the lymphoma has not grown for 6 years. The sandwich sign is the cross-sectional imaging appearance of mesenteric vascular trunk and fat as the sandwich filling and the bulky soft-tissue tumours as the two halves of a sandwich bun [1]. It may present ‘thunder in the cloud’ sign on the coronal reconstruction CT images [2]. Mesenteric lymphoma has characteristic features of bulky growth with enveloping mesenteric vessels, fat, and bowel but rarely causing perforation [1]. This sign is specific to mesenteric lymphoma and can be used in differentiating between tuberculous lymphadenopathy and mesenteric lymphoma [3].
Fig. 1. CT scan showing two mesenteric tumours, encasing the superior mesenteric artery (arrow) within the left hemiabdomen, consistent with the sandwich sign.
⇑ Corresponding author. Address: Department of Endoscopy, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan. Tel.: +81 98 895 1144; fax: +81 98 895 1414. E-mail address: [email protected] (A. Hokama).
Fig. 2. Three dimensional CT scan showing mesenteric vessels traverse the tumour (arrow) without distortion.
http://dx.doi.org/10.1016/j.ajg.2014.07.001 1687-1979/Ó 2014 Arab Journal of Gastroenterology. Published by Elsevier B.V. All rights reserved.
158
T. Maeshiro et al. / Arab Journal of Gastroenterology 15 (2014) 157–158
Financial disclosures None. Conflict of interest The authors declared that there was no conflict of interest.
References [1] Hardy SM. The sandwich sign. Radiology 2003;226:651–2. [2] Hokama A, Nakamoto M, Kinjo F, et al. ‘The sandwich sign’ of mesenteric lymphoma. Eur J Haematol 2006;77:363–4. [3] Dong P, Wang B, Sun QY, et al. Tuberculosis versus non-Hodgkin’s lymphomas involving small bowel mesentery: evaluation with contrast-enhanced computed tomography. World J Gastroenterol 2008;14:3914–8.
