Comparative study of intestinal tuberculosis and primary small intestinal lymphoma.
OBJECTIVE
To characterize the clinical, radiological, endoscopic and pathological features of intestinal tuberculosis (ITB) and primary small intestinal lymphoma (PSIL).


METHODS
This was a retrospective study from February 2005 to October 2012 of patients with a diagnosis of ITB (n = 41) or PSIL (n = 37). All patients with ITB or PSIL underwent computed tomography (CT) and pathological examination. Thirty-five patients with ITB and 32 patients with PSIL underwent endoscopy. These patients were followed for a further 18 mo to ascertain that the diagnosis had not changed. Clinical, endoscopic, CT and pathological features were compared between ITB and PSIL patients.


RESULTS
Night sweating, fever, pulmonary TB and ascites were discovered significantly more often in ITB than in PSIL patients (P < 0.05), however, abdominal mass, hematochezia and intestinal perforation were found significantly more frequently in PSIL than in ITB patients (P < 0.05). Ring-like and rodent-like ulcers occurred significantly more often in ITB than in PSIL patients (P < 0.05), however, enterorrhagia and raised lesions were significantly more frequent in PSIL than in ITB patients (P < 0.05). The rate of granuloma was significantly higher in ITB than in PSIL patients (87.8% vs 13.5%, χ(2) = 43.050, P < 0.05), and the incidence of confluent granulomas with caseous necrosis was significantly higher in ITB than in PSIL patients (47.2% vs 0.0%, χ(2) = 4.034, P < 0.05). Multi-segmental lesions, mural stratification, mural gas sign, and intestinal stricture were more frequent in ITB than in PSIL patients (P < 0.05), however, a single-layer thickening of bowel wall, single segmental lesions, and intussusception were more common in PSIL than in ITB patients (P < 0.05). Necrotic lymph nodes, comb sign and inflammatory mass were more frequent in ITB than in PSIL patients (P < 0.05). The bowel wall enhancement in ITB patients was greater than that in PSIL patients (P < 0.05), while the thickening and lymph node enlargement in PSIL patients were higher than those in ITB patients (P < 0.05).


CONCLUSIONS
Combined evaluation of clinical, radiological, endoscopic and pathological features is the key to differentiation between ITB and PSIL.
Qing-Qiang Zhu, Wen-Rong Zhu, Jing-Tao Wu, Wen-Xin Chen, Shou-An Wang, Department of Medical Imaging, Subei People's Hospital, Medical School of Yangzhou University, Yangzhou 225001, Jiangsu Province, China.
Qing-Qiang
QQ
Zhu
Qing-Qiang Zhu, Wen-Rong Zhu, Jing-Tao Wu, Wen-Xin Chen, Shou-An Wang, Department of Medical Imaging, Subei People's Hospital, Medical School of Yangzhou University, Yangzhou 225001, Jiangsu Province, China.
Wen-Rong
WR
Zhu
Qing-Qiang Zhu, Wen-Rong Zhu, Jing-Tao Wu, Wen-Xin Chen, Shou-An Wang, Department of Medical Imaging, Subei People's Hospital, Medical School of Yangzhou University, Yangzhou 225001, Jiangsu Province, China.
Jing-Tao
JT
Wu
Qing-Qiang Zhu, Wen-Rong Zhu, Jing-Tao Wu, Wen-Xin Chen, Shou-An Wang, Department of Medical Imaging, Subei People's Hospital, Medical School of Yangzhou University, Yangzhou 225001, Jiangsu Province, China.
Wen-Xin
WX
Chen
Qing-Qiang Zhu, Wen-Rong Zhu, Jing-Tao Wu, Wen-Xin Chen, Shou-An Wang, Department of Medical Imaging, Subei People's Hospital, Medical School of Yangzhou University, Yangzhou 225001, Jiangsu Province, China.
Shou-An
SA
Wang
D000328:Adult; D003937:Diagnosis, Differential; D004724:Endoscopy; D006801:Humans; D007249:Inflammation; D007414:Intestinal Neoplasms / Q000175:diagnosis*; D007422:Intestines / Q000473:pathology*; D008223:Lymphoma / Q000175:diagnosis*; D008297:Male; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014385:Tuberculosis, Gastrointestinal / Q000175:diagnosis*
Clinical features; Computed tomography; Endoscopic features; Intestinal tuberculosis; Primary small intestinal lymphoma