Jejunal perforation: a rare presentation of B-cell lymphoma

Emergency laparotomy for abdominal catastrophes secondary to lymphoma: A systematic review

Intestinal lymphomas can rarely present as abdominal catastrophes with perforation or small bowel obstruction. There is little data regarding their optimal surgical management and associated outcomes. We aimed to systematically review relevant published literature to assess the presentation, diagnosis, optimal surgical approach and associated post-operative outcomes. A systematic on-line literature search of Embase and Medline identified 1485 articles of which 34 relevant studies were selected, including 7 retrospective studies, 1 case series and 26 case reports. Selected articles were assessed by two reviewers to extract data. 95 patients with abdominal catastrophes secondary to lymphoma (predominately Burkitt (28 %) and Diffuse Large B-cell lymphoma (29 %)) were identified with a median age of 52 years, 40 % were female. Of the small bowel resections 25% (n = 18) suffered post-operative complications with a 13.8 % (n = 10) 30-day mortality. Ileocolonic resections had a 27 % complication rate with 18 % mortality and primary repair had a 25 % complications rate and 25 % mortality. Median follow-up was 8 days (range 1-96). Notable points of differences in the presentations between these different lymphomas included the majority of Burkitt's lymphoma were younger, had a known diagnosis, were on chemotherapy and presented with perforation in contrast to those with B cell lymphoma who were predominately older, had new diagnoses and presented with a balanced proportion of obstruction and perforation. Abdominal catastrophes secondary to intestinal lymphomas most commonly present with perforation. Aggressive surgical management, including small bowel resection, may offer similar remission rates for lymphoma patients presenting with abdominal catastrophes as those without such emergency complications.

Primary colorectal diffuse large B-cell lymphoma initially presenting with pleural effusion: report of one case and review of literature

Gastrointestinal (GI) diffuse large B-cell lymphoma (DLBCL) is one of the frequently reported histologic subtypes of non-Hodgkin lymphoma (NHL) that occur in the GI tract. However, the presentation of quite different clinical manifestations, morphologic characteristics, immunophenotypes, and molecular biologic features is challenging for its diagnosis. Herein, we describe a rare case of primary colorectal DLBCL that occurred in a 59-year-old immunocompetent Chinese female who attended our respiratory clinic for the third time with an asymptomatic pleural effusion and pleural thickening. In her clinical setting, there was no history of trauma or travel, and no evidence of infections, connective tissue diseases, or malignancies such as pleural mesothelioma. Lymphoma was highly suspected for the enlargement of systemic lymph nodes and the multiple polypoid appearance in the rectum found by endoscopy examination. In a repeated colonoscopy, immunohistochemical and molecular features of the multiple "polyps" allowed diagnosis of colorectal diffuse large B-cell NHL. To our knowledge, this is the first case of a verified diagnosis of pleural effusion associated with a primary colorectal DLBCL. The purpose of this report is to alert clinicians that when we evaluate the causes of unexplained pleural effusion, lymphoma should be considered, particularly when the available examination data cannot be corroborated by clinical manifestations.

Primary extranodal jejunal diffuse large B cell lymphoma as a diagnostic challenge for intractable emesis: a case report and review of literature

Introduction: The gastrointestinal tract is the most common extranodal site for non-Hodgkin's lymphoma, with the most common being diffuse large B cell lymphoma. Unlike the stomach or the ileum, the jejunum is a rare site for primary extranodal lymphomas, given the scarcity of lymphoid tissue. Due to its location, inflammation in the jejunum may not be visualized on routine imaging or endoscopy, making jejunal lymphoma difficult to diagnose. Case Description: We present a case of a 90-year-old male with 1 week of intractable emesis, initially thought to be due to viral gastroenteritis. His symptoms never improved and he underwent serial CT imagings in addition to esophagogastroduodenoscopy. A stomach biopsy and a diagnostic paracentesis did not reveal any malignant cells, but a CT enterography revealed significant jejunal inflammation with obstruction. After a month of hospitalization, a jejunal biopsy was obtained, which showed proliferation of neoplastic B cells. He was ultimately diagnosed with primary jejunal diffuse large B cell lymphoma. Discussion: Chemotherapy and surgical resection are typically the definitive treatment for extranodal lymphoma. Clinicians, however, must carefully consider the patient's functional and nutritional statuses before offering such interventions. This case was a diagnostic challenge and demonstrated a rare GI malignancy's convoluted mimicking nature.