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Mesenteric lymphoma refers to primary or secondary involvement of the mesentery by lymphoid malignancy, most commonly non-Hodgkin’s lymphoma (NHL). It may present as enlarged mesenteric lymph nodes, confluent soft-tissue masses, or diffuse infiltration of mesenteric fat.

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Etiopathogenesis

Usually secondary involvement from systemic lymphoma.
Primary mesenteric lymphoma is rare.
Common histological subtypes: diffuse large B-cell lymphoma (DLBCL), follicular lymphoma, Burkitt’s lymphoma.
Pathogenesis: uncontrolled proliferation of malignant lymphocytes within mesenteric nodes → coalescent masses encasing mesenteric vessels.

Clinical Features

Abdominal mass (deep, non-tender).
Abdominal pain, distension, or early satiety.
Weight loss, night sweats, fever (“B symptoms”).
Bowel obstruction (rare – lymphoma tends to encase but not obstruct).
Ascites in advanced disease.

Radiology

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Mesenteric lymphoma classically presents as bulky, homogeneous masses encasing mesenteric vessels (sandwich sign) without obstruction, distinguishing it from desmoplastic or infiltrative mesenteric neoplasms.

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Modality	Imaging features
US	• Multiple hypoechoic mesenteric nodal masses.
• May appear as a homogeneous “sandwich” mass around vessels.
CT	• Classic “Sandwich sign”: Homogeneous soft tissue masses enveloping mesenteric vessels and fat without vascular narrowing.
• Bulky, confluent lymphadenopathy in root of mesentery.
• Encases superior mesenteric artery/vein without occlusion.
• Homogeneous soft tissue density, minimal necrosis (unless aggressive type).
• Associated bowel wall thickening (lymphomatous infiltration).
• May extend to retroperitoneal/para-aortic nodes.
• Calcification: rare, unless post-treatment.
MR	• T1: hypointense; T2: hyperintense; homogeneous post-contrast enhancement.
• Helps in tissue characterization, follow-up.
PET-CT	• High FDG uptake (except in some indolent types).
• Useful for staging, treatment response.

Etiopathogenesis

Clinical Features

Radiology

Differentials