Acute appendicitis in a man undergoing therapy for mantle cell lymphoma

Mantle Cell Lymphoma Presenting as Acute Abdominal Syndrome: A Rare Case Report and Literature Review

BACKGROUND

Acute abdominal syndrome can be caused by several possible reasons. The most common causes are perforation of a gastroduodenal ulcer, peritonitis, intestinal obstructions, and perforation of an appendix or fallopian tube. Fever and pain can be caused by an appendicitis or sigmoiditis. Appendiceal lymphoma is a rare disease that is usually found incidentally during appendectomy. Most of the cases are non-Hodgkin's lymphomas. Mantle cell lymphoma is an aggressive B-cell non-Hodgkin's lymphoma with a poorer prognosis than other B-cell lymphomas; thus, a definitive diagnosis is essential.

CASE SUMMARY

A 60-year-old man presented with right lower quadrant pain. He denied any nausea, vomiting or anorexia and was afebrile. The physical examination revealed right lower quadrant abdomen tenderness. The computed tomography scan revealed periappendiceal fatty stranding with a swollen appendix, approximately 2 cm in diameter and prominent paraaortic, portacaval and mesenteric lymph nodes. A diagnosis of acute appendicitis was made, and laparoscopic appendectomy was performed immediately. The subsequent pathological examination revealed severe congestion with lymphoid hyperplasia. The immunohistochemistry stains revealed positive staining for cluster of differentiation (CD) CD20, B-cell lymphoma-2 (Bcl-2), cyclin D1, SRY-box transcription factor-11 (SOX-11), immunoglobulin D (IgD) and immunoglobulin M (IgM) but negative staining for CD3, CD5, CD10 and CD23. 18F-FDG positron emission tomography showed peripheral lymph node involvement, while the bone marrow biopsy showed negative findings. Therefore, a diagnosis of mantle cell lymphoma, Ann Arbor stage IVA, was made. The patient received postoperative combination chemotherapy and remained in a stable condition over a 1-year follow-up period.

CONCLUSION

We report an uncommon case that initially presented as acute appendicitis, for which a final diagnosis of mantle cell lymphoma was made. In comparison with other B-cell lymphomas, mantle cell lymphoma has a poorer prognosis, and positive immunochemical staining of cyclin D1 and SOX-11 is useful for differentiating mantle cell lymphoma from other appendiceal lymphomas and treating patients appropriately. Physicians and nursing staff should be also aware of the associated complications and management in these patients.

Mantle cell lymphoma presenting as acute appendicitis

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Mantle cell lymphoma is an extremely rare form of lymphoma associated with appendicitis.

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This is one of few reported cases of mantle cell lymphoma showing obstruction of appendiceal lumen.

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Appendicitis associated with mantle cell lymphoma in this incident is unaffected by the effect of chemotherapy treatments.

INTRODUCTION

Most cases of appendicitis associated with lymphoma reported in literature are in patients with Burkitt's or large B-cell lymphoma. Mantle cell lymphoma only makes up 4% of all lymphoma cases in the U.S. We report a case of a patient with mantle cell lymphoma presenting with acute appendicitis.

PRESENTATION OF CASE

A 75 year old male with a history of left cervical lymphadenopathy biopsied to be mantle cell lymphoma presented with right lower abdomen pain for 3 days. An outpatient CT scan revealed acute appendicitis. Laparoscopic appendectomy was performed without any complication. The histologic examination showed mantle cell lymphoma occluding the lumen of appendix.

DISCUSSION

Typically, appendicitis is caused by obstruction of the lumen of appendix by fecalith or lymphoma. A previously reported case of a patient with mantle cell lymphoma who developed appendicitis received chemotherapy before appendectomy. The author could not determine how mantle cell lymphoma contributed to appendicitis because the lumen of appendix was not occluded by the lymphoma, likely from cytoreduction from chemotherapy. We have a patient with mantle cell lymphoma before the patient received chemotherapy who presented with appendicitis. The appendiceal specimen shows the lumen filled with mantle cell lymphoma.

CONCLUSION

This is a rare case of mantle cell lymphoma causing obstruction of appendiceal lumen and subsequently appendicitis, unaffected by chemotherapy.