Ileocolonic Lymphoma Presenting as Intussusception

Le résumé fourni par la source

Primary ileocolonic lymphomas have recently been endoscopically classified according to colonoscopic findings (Gastrointest Endosc. 2003 Mar;57(3):343–7). The current classification system describes 5 groups: fungating, ulcerofungating, infiltrative, ulceroinfiltrative, and ulcerative. We report a case in which a patient presented with ileocolonic lymphoma that could not be classified endoscopically by the current classification system. The patient is a 56 year-old female who presented to the emergency room with a 4 week history of lower abdominal crampy pain. An abdominal CT scan revealed a 4 cm soft tissue mass in the cecum with extension to the terminal ileum. A colonoscopy was performed. There was a 4 cm ulcerated mass extending from the cecum to the proximal ascending colon. Multiple biopsies revealed fragments of benign colonic mucosa with inflammatory changes but without malignant cells. Due to persistent pain and the fear of an underlying submucosal malignancy, a laproscopy was performed. Operative findings revealed that the colonic mass was originating from intussusception of a mass in the terminal ileum. Following resection and primary anastomosis, the patient did well. Pathology revealed a diffuse large B-cell lymphoma. The patient experienced an uncomplicated post-operative course and was discharged with plans for outpatient chemotherapy. This represents a rare case of adult ileocolonic intussusception caused by diffuse large B-cell lymphoma of the terminal ileum. Although there was an ulceration, this was related to ischemia to the normal mucosa from the intussusception. The ileocolonic lymphoma was entirely submucosal. Based on this case report, we suggest modification to the current classification system to include a “submucosal” presentation. Ileocolonic lymphoma can present as a submucosal mass in the cecum related to intussusception.

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