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Adupa R, Dadigiri H, Gandhi D. Partial Small Bowel Obstruction and Volvulus Due to B-cell Lymphoma in a Common Variable Immunodeficiency Patient. Cureus 2023; 15:e47269. [PMID: 38021662 PMCID: PMC10655833 DOI: 10.7759/cureus.47269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
This case report presents a 43-year-old female with a history of common variable immunodeficiency (CVID) and a recent diagnosis of mesenteric volvulus. The patient presented with symptoms of partial small bowel obstruction and was diagnosed with obstruction and mesenteric volvulus primarily affecting the proximal jejunum. During the exploratory laparotomy, a probable polyposis syndrome and a possible adenocarcinoma of the small bowel were identified. Pathological examination confirmed the presence of B-cell lymphoma in the proximal jejunum. The patient underwent treatment with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (RCHOP) chemotherapy and showed improvement in symptoms. The case highlights the increased risk of malignancies, particularly lymphomas, in individuals with CVID and the challenges in diagnosing and treating lymphoid neoplasms in this population.
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Affiliation(s)
- Reshmi Adupa
- Internal Medicine, New York Medical College at St. Mary's General Hospital, Passaic, USA
- Internal Medicine, New York Medical College at St. Clare's Health, Denville, USA
| | - Harika Dadigiri
- Internal Medicine, Sri Venkateswaraa Medical College, Tirupati, IND
| | - Darshan Gandhi
- Internal Medicine, New York Medical College at St. Mary's General Hospital, Passaic, USA
- Internal Medicine, New York Medical College at St. Clare's Health, Denville, USA
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2
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Tian FY, Wang JX, Huang G, An W, Ai LS, Wang S, Wang PZ, Yu YB, Zuo XL, Li YQ. Clinical and endoscopic features of primary small bowel lymphoma: a single-center experience from mainland China. Front Oncol 2023; 13:1142133. [PMID: 37397371 PMCID: PMC10313208 DOI: 10.3389/fonc.2023.1142133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/01/2023] [Indexed: 07/04/2023] Open
Abstract
Objective The worldwide incidence of primary small intestinal lymphoma (PSIL) is increasing. However, little is known about the clinical and endoscopic characteristics of this disease. The aim of this study was to investigate the clinical and endoscopic data of patients with PSIL, with the goal of enhancing our understanding of the disease, improving diagnostic accuracy, and facilitating more accurate prognosis estimation. Methods Ninety-four patients diagnosed with PSIL were retrospectively studied at Qilu Hospital of Shandong University between 2012 and 2021. The clinical data, enteroscopy findings, treatment modalities, and survival times were collected and analyzed. Results Ninety-four patients (52 males) with PSIL were included in this study. The median age of onset was 58.5 years (range: 19-80 years). Diffuse large B-cell lymphoma (n=37) was the most common pathological type. Abdominal pain (n=59) was the most frequent clinical presentation. The ileocecal region (n=32) was the most commonly affected site, and 11.7% of patients had multiple lesions. At the time of diagnosis, the majority of patients (n=68) were in stages I-II. A new endoscopic classification of PSIL was developed, including hypertrophic type, exophytic type, follicular/polypoid type, ulcerative type, and diffusion type. Surgery did not show a significant increase in overall survival; chemotherapy was the most commonly administered treatment. T-cell lymphoma, stages III-IV, "B" symptoms, and ulcerative type were associated with poor prognosis. Conclusion This study provides a comprehensive analysis of the clinical and endoscopic features of PSIL in 94 patients. This highlights the importance of considering clinical and endoscopic characteristics for accurate diagnosis and prognosis estimation during small bowel enteroscopy. Early detection and treatment of PSIL is associated with a favorable prognosis. Our findings also suggest that certain risk factors, such as pathological type, "B" symptoms, and endoscopic type, may affect the survival of PSIL patients. These results underscore the need for careful consideration of these factors in the diagnosis and treatment of PSIL.
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Affiliation(s)
- Feng-Yu Tian
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Jue-Xin Wang
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Gang Huang
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Wen An
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Li-Si Ai
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Sui Wang
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Pei-Zhu Wang
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Yan-Bo Yu
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Digestive Disease, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
| | - Xiu-Li Zuo
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Digestive Disease, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
| | - Yan-Qing Li
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Digestive Disease, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
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3
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Dias E, Medas R, Marques M, Andrade P, Cardoso H, Macedo G. Clinicopathological characteristics and prognostic factors of small bowel lymphomas: a retrospective single-center study. Porto Biomed J 2023; 8:e217. [PMID: 37362020 PMCID: PMC10289779 DOI: 10.1097/j.pbj.0000000000000217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/21/2023] [Indexed: 06/28/2023] Open
Abstract
Background There is little information on diagnosis and management of small bowel lymphomas, and optimal management strategies are still undefined. This study aims to describe their main clinical and pathological characteristics and identify poor prognostic factors. Methods A retrospective observational study of all patients with histological diagnosis of small bowel lymphoma between January 2010 and December 2020 was performed. Results We included 40 patients, with male predominance (60%) and mean age of 60.7 years. The ileum was the most common location, and the most common histological subtypes were follicular lymphoma and diffuse large B-cell lymphoma. Clinical presentation was variable from asymptomatic patients (30%) to acute surgical complications (35%) including perforation, intestinal obstruction, ileal intussusception, or severe bleeding. Diagnosis was established by endoscopy in 22 patients (55%), and the most common findings included polyps, single mass, diffuse infiltration, or ulceration, whereas 18 (45%) required surgery because of acute presentations or tumor resection, and lymphoma was diagnosed postoperatively. Surgery was curative in one-third of those patients. Median survival was 52 months. Acute presentation (P = 0.001), symptomatic disease (P = 0.003), advanced stage (P = 0.008), diffuse large B-cell lymphoma (P = 0.007), anemia (P = 0.006), hypoalbuminemia (P < 0.001), elevated lactate dehydrogenase (P = 0.02), elevated C-reactive protein (P < 0.001), and absence of treatment response (P < 0.001) were significant predictors of mortality. Conclusion Small bowel lymphoma is a rare malignancy with diverse clinical and endoscopic presentations that require a high index of suspicion. Primary factors associated with worse outcome included acute presentation, advanced stage, histological subtype, biochemical abnormalities, and absence of treatment response.
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Affiliation(s)
- Emanuel Dias
- Corresponding author. Address: Gastrenterology Department, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal. E-mail address: (Emanuel Dias)
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4
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Lu PW, Fields AC, Yoo J, Irani J, Goldberg JE, Bleday R, Melnitchouk N. Surgical Management of Small Bowel Lymphoma. J Gastrointest Surg 2021; 25:757-765. [PMID: 32666499 DOI: 10.1007/s11605-020-04730-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/30/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Primary small bowel non-Hodgkin's lymphoma is a rare disease representing 2% of small intestine malignancies. There is limited data delineating the optimal treatment for these heterogeneous tumors. We aim to examine relationships between different treatment modalities and surgical outcomes in patients with small bowel lymphoma. MATERIALS AND METHODS Patients diagnosed with stage I-III small bowel lymphoma in 2004-2015 who underwent surgery were identified in the National Cancer Database. Two cohorts were created based on systemic chemotherapy treatment status. The primary outcome was overall survival. An adjusted Cox proportional hazards model was used to evaluate the impact of treatment strategy on survival. RESULTS 2283 patients met inclusion criteria Of these patients, 826 patients (36%) underwent surgical resection alone, and 1457 patients (64%) underwent resection with systemic chemotherapy. Chemotherapy was associated with improved overall survival in unadjusted (5-year overall survival, 55% versus 70%) and adjusted analysis (HR 0.54, 95% CI 0.47-0.63, p < 0.001). DISCUSSION Patients with small bowel lymphoma have a low five-year overall survival after surgery. Chemotherapy is associated with improved survival, although one third of patients do not receive this therapy. Several other clinical factors are identified that are also associated with overall survival, including histology subtype, margin status, age, and medical comorbidities. This information can help with prognostication and potentially aid in treatment decision-making.
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Affiliation(s)
- Pamela W Lu
- Division of Colorectal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. .,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Adam C Fields
- Division of Colorectal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - James Yoo
- Division of Colorectal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Jennifer Irani
- Division of Colorectal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Joel E Goldberg
- Division of Colorectal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Ronald Bleday
- Division of Colorectal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Nelya Melnitchouk
- Division of Colorectal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. .,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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5
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Sugimoto K, Uejima S, Uchiyama Y, Yasue R, Nambu K, Ishikawa J, Koma Y, Akita T, Toh T, Fujimoto T. Metachronous primary cancer of the tongue and malignant lymphoma of the small intestine: A case report. Medicine (Baltimore) 2021; 100:e24806. [PMID: 33607843 PMCID: PMC7899883 DOI: 10.1097/md.0000000000024806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/29/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Oral cancer often causes secondary primary cancers in the upper gastrointestinal tract. However, there are no reports of secondary primary cancers in patients with oral squamous cell carcinoma and malignant lymphoma of the small intestine. This report describes a case of metachronous multiple primary cancers of the tongue and small intestine malignant lymphoma. PATIENTS CONCERNS The patient was admitted to our department with the chief complaint of pain in the right tongue. Partial tongue resection and supraomohyoid neck dissection were performed. One year after surgery, the patient experienced abdominal pain and bloody stools. DIAGNOSIS Diffuse large B-cell lymphoma (DLBCL) was diagnosed via histological examination. INTERVENTIONS A terminal ileum resection was performed. Postoperatively, the patient received 6 courses of rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisone (R-CHOP). OUTCOMES Five years after his initial diagnosis, there is no evidence of recurrence, metastasis, or other primary cancer. LESSONS Oral cancer patients should always be followed up owing to a possibility of malignant tumors in other areas.
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Affiliation(s)
- Keisuke Sugimoto
- Department of Oral and Maxillofacial Surgery, Iwata City Hospital, Iwata
| | - Shinji Uejima
- Department of Oral and Maxillofacial Surgery, Nagoya University Hospital
| | - Yumiko Uchiyama
- Department of Oral and Maxillofacial Surgery, Iwata City Hospital, Iwata
| | - Reita Yasue
- Department of Oral and Maxillofacial Surgery, Iwata City Hospital, Iwata
| | - Kazuya Nambu
- Department of Oral and Maxillofacial Surgery, Iwata City Hospital, Iwata
| | - Jun Ishikawa
- Department of Oral and Maxillofacial Surgery, Iwata City Hospital, Iwata
| | - Yoshiro Koma
- Department of Oral and Maxillofacial Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya
| | - Takako Akita
- Department of Oral and Maxillofacial Surgery, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, Japan
| | - Taketomo Toh
- Department of Oral and Maxillofacial Surgery, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, Japan
| | - Takehiro Fujimoto
- Department of Oral and Maxillofacial Surgery, Iwata City Hospital, Iwata
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6
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Sabbah M, Ben Farhat F, Bellil N, Khanchel F, Ouakaa A, Gargouri D. An unusual case of diffuse large B-cell lymphoma complicating a Crohn's disease. Clin Case Rep 2020; 8:3062-3065. [PMID: 33363880 PMCID: PMC7752437 DOI: 10.1002/ccr3.3364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/08/2020] [Accepted: 08/24/2020] [Indexed: 11/13/2022] Open
Abstract
Clinicians should keep in mind that Crohn's disease may be complicated by neoplasia such as adenocarcinomas or lymphomas, especially if the disease duration is long and the patient is under immunosuppressive therapy.
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Affiliation(s)
- Meriam Sabbah
- Department of GastroenterologyHabib Thameur HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Fatma Ben Farhat
- Department of GastroenterologyHabib Thameur HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Nawel Bellil
- Department of GastroenterologyHabib Thameur HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Fatma Khanchel
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
- Department of PathologyHabib Thameur HospitalTunisTunisia
| | - Asma Ouakaa
- Department of GastroenterologyHabib Thameur HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Dalila Gargouri
- Department of GastroenterologyHabib Thameur HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
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7
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Wagh AN, Ganesan B, Jawale HM, Mishra RA, Bhatt R. A rare case report of large B cell lymphoma in adult presentation as intussusception. Clin Pract 2020; 10:1292. [PMID: 33123336 PMCID: PMC7586136 DOI: 10.4081/cp.2020.1292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/25/2020] [Indexed: 11/23/2022] Open
Abstract
Adult intussusception represents 5% of all intussusceptions. Primary gastro-intestinal lymphoma comprises 1%-4% of all gastro- intestinal malignancies 90% of them are B-cell non-Hodgkin's lymphoma (NHL). Most common NHL is diffuse large B-cell lymphoma accounts for 30-40%. Most common lymphoma causing intussusception is diffuse large B-cell lymphoma (DLBCL). We herein report a rare case of ileo-colic intussusception due to DLBCL in a 50- years-old male. Computed tomography showed ileo-colic intussusception with possibility of neoplastic etiology as a lead point. Hemicolectomy with ileo-colic anastomosis was done laparoscopically with post-operative chemotherapy. Subsequently, whole body positron emission tomography-computed tomography verified complete resolution of the malignancy. This study aims to present a rare case of ileo-colic intussusception due to non- Hodgkin's B-cell lymphoma in a patient with unusual clinical course and highlight the importance of not only the timely surgical intervention but also the significance of strict adherence to follow up and chemotherapy will completely eradicate the malignancy.
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Affiliation(s)
| | | | - Hemant M. Jawale
- Department of General Surgery, Grant Government Medical College and Sir J.J. group of Hospitals, Mumbai, India
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8
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Park JW, Song GA, Baek DH, Kim GH, Lee BE, Lee MW, Han SY, Park YJ, Park EY. Adult Ileocolic Intussusception Caused by Diffuse Large B Cell Lymphoma. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2020; 75:46-49. [PMID: 31986573 DOI: 10.4166/kjg.2020.75.1.46] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 10/02/2019] [Indexed: 12/22/2022]
Abstract
Intussusception is a medical condition, in which a proximal part of the intestine folds into the distal intestine. Adult intussusceptions are rare and account for approximately 5% of all cases of intussusceptions. The anatomical leading points include tumors, diverticulums, polyps, and strictures in 80-90% of adult intussusceptions, and 65% of colon intussusceptions and 30% of small bowel intussusceptions originate from malignant tumors. Treatments for adult intussusception have not been established, but most cases require surgical treatment. The gastrointestinal tract is the most common extranodal site for non-Hodgkin lymphoma. The symptoms are mostly non-specific, but they rarely lead to complications, such as bleeding, perforation, and intussusception. Furthermore, few cases of primary gastrointestinal lymphomas causing intussusception have been reported. This paper reports a case of small bowel diffuse large B cell lymphoma that caused ileocolic intussusception in a 69-year-old woman with no medical history. She underwent a small bowel resection and received six cycles of adjuvant chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone. Since then, she has been in complete remission.
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Affiliation(s)
- Joon Woo Park
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Bong Eun Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Moon Won Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sung Yong Han
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Young Joo Park
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Eun Young Park
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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9
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Experience with Balloon Dilatation in Crohn's and Non-Crohn's Benign Small-Bowel Strictures: Is There a Difference? Gastroenterol Res Pract 2019; 2019:1262595. [PMID: 31198420 PMCID: PMC6526561 DOI: 10.1155/2019/1262595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/06/2019] [Accepted: 03/21/2019] [Indexed: 11/17/2022] Open
Abstract
Background/Aim Endoscopic balloon dilation (EBD) has been effective for small-bowel strictures in patients with Crohn's disease (CD). However, its efficacy and indication for small-bowel strictures in non-CD patients have not been established. This study evaluated the clinical efficacy and safety of EBD for small-bowel strictures in non-CD patients compared with CD patients. Methods Ninety-eight consecutive patients (mean age, 53 years; average observation period, 45 months) with small-bowel strictures diagnosed by double-balloon endoscopy were retrospectively evaluated at Hiroshima University Hospital from August 2003 to April 2017. The average number of procedures, short-term and long-term EBD success rates, and safety profiles between the non-CD and CD groups were examined. Results Surgery was selected as the initial treatment in 44 cases (45%) (non-CD group, 27 (61%); CD group, 17 (39%)) as EBD is not indicated. Fourteen non-CD patients had strictures due to malignant tumors, while 13 patients had benign strictures. Twenty-three patients (non-CD, 12; CD, 11) underwent EBD. Forty-three EBD procedures were performed for 17 stricture sites (average: 2.5 procedures/site) in non-CD patients and 41 EBD procedures for 18 stricture sites (average: 2.3 procedures/site) in CD patients. The short-term success rate was 100% (23/23), whereas the long-term success rate was 92% (11/12) in non-CD patients and 82% (9/11) in CD patients. No significant differences in the surgery-free rate occurred between both groups. Furthermore, one adverse event, bleeding after EBD, was encountered in the non-CD group (8%, 1/12). Conclusion EBD for small-bowel strictures demonstrated good clinical outcomes in non-CD patients.
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10
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Zaarour M, Busack C, Munker R. Obstructing Duodenal Diffuse Large B-cell Lymphoma with Peritoneal Lymphomatosis with Exceptional Response to R-CHOP. Cureus 2019; 11:e4621. [PMID: 31312548 PMCID: PMC6615582 DOI: 10.7759/cureus.4621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Primary small bowel tumors are uncommon and usually carry a poor prognosis. Adenocarcinoma is the predominant histological type while lymphoma is far less common. Small bowel diffuse large B-cell lymphoma (DLBCL) can mimic adenocarcinoma; thus, the distinction can be challenging before tissue examination is performed. Bowel obstruction, as well as peritoneal involvement, are often seen in gastrointestinal (GI) adenocarcinoma cases; however, these features are extremely uncommon with GI lymphomas. Herein, the authors report an unusual case of an obstructing duodenal mass with peritoneal involvement, which was highly suspicious for an advanced duodenal adenocarcinoma. Surprisingly, sampling of the tumor revealed a diffuse large B-cell lymphoma.
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Affiliation(s)
- Mazen Zaarour
- Hematology and Oncology, Tulane University School of Medicine, New Orleans, USA
| | - Christopher Busack
- Internal Medicine, Tulane University School of Medicine, New Orleans, USA
| | - Reinhold Munker
- Hematology and Oncology, Tulane University School of Medicine, New Orleans, USA
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11
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İflazoğlu N, Mengeloğlu A, Korkmaz NŞ, Karaalioğlu B, Yülüklü M. Primary small bowel lymphoma presenting as invagination. Turk J Surg 2018; 34:331-333. [PMID: 30664435 DOI: 10.5152/turkjsurg.2017.3115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 06/10/2015] [Indexed: 11/22/2022]
Abstract
One of the causes of invagination in adults is primary small bowel lymphoma. Primary small bowel lymphomas are rare, present themselves with complications due to diagnostic difficulties, and are diagnosed only after surgical intervention. In case of invagination, one of the complications of these tumors, namely primary small bowel lymphoma, should also be considered as a cause in the diagnosis. In this paper, the diagnosis and therapy of a rare case of primary polypoid-type small intestinal lymphoma demonstrating findings of obstruction due to invagination have been presented and discussed in the light of the literature.
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Affiliation(s)
- Nidal İflazoğlu
- Department of General Surgery, Kilis State Hospital, Kilis, Turkey
| | - Aslı Mengeloğlu
- Department of Pathology, Kilis State Hospital, Kilis, Turkey
| | | | - Bilgin Karaalioğlu
- Department of Intarnal Medicine, Şanlıurfa Mehmet Akif İnan Training and Research Hospital, Şanlıurfa, Turkey
| | - Murat Yülüklü
- Department of General Surgery, Afyon State Hospital, Afyon, Turkey
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12
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Intussusception of a small bowel large B-cell lymphoma. Indian J Surg Oncol 2014; 5:142-3. [PMID: 25114468 DOI: 10.1007/s13193-014-0304-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 03/10/2014] [Indexed: 10/25/2022] Open
Abstract
Gastrointestinal tumors can rarely cause intestinal intussusception. Herein, we describe a 74 year-old male with a presumed diagnosis of Crohn's disease who presented with persistent symptoms refractory to medical management. Radiography demonstrated small bowel intussusception into the cecum. Lower endoscopy with biopsy diagnosed small bowel large Bcell lymphoma. Management included laparoscopic ileocecectomy and adjuvant R-CHOP chemotherapy. Long term outcomes of small bowel large B-cell lymphoma are related to disease stage at diagnosis, and average close to 75 %.
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13
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Xu XQ, Hong T, Li BL, Liu W. Ileo-ileal intussusception caused by diffuse large B-cell lymphoma of the ileum. World J Gastroenterol 2013; 19:8449-8452. [PMID: 24363540 PMCID: PMC3857472 DOI: 10.3748/wjg.v19.i45.8449] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 10/14/2013] [Accepted: 10/22/2013] [Indexed: 02/06/2023] Open
Abstract
The occurrence of adult intussusception from small intestinal lymphoma is quite rare. We present an 82-year-old man with a two-month history of intermittent abdominal pain, nausea and fatigue. Clinical symptoms included moderate abdominal tenderness in the right lower abdomen. Computed tomography scan of the abdomen revealed a mass in the terminal ileum with the sign of “bowel within bowel” which was suspicious of ileo-ileum intussusception. The patient underwent laparoscopic segmental ileal resection. Pathologic evaluation revealed a diffuse large B cell non-Hodgkin’s lymphoma of the ileum. The postoperative course was uneventful.
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MESH Headings
- Aged, 80 and over
- Biomarkers, Tumor/analysis
- Biopsy
- Endoscopy, Gastrointestinal
- Humans
- Ileal Diseases/diagnosis
- Ileal Diseases/etiology
- Ileal Diseases/surgery
- Ileal Neoplasms/chemistry
- Ileal Neoplasms/complications
- Ileal Neoplasms/diagnosis
- Ileal Neoplasms/surgery
- Immunohistochemistry
- Intussusception/diagnosis
- Intussusception/etiology
- Intussusception/surgery
- Lymphoma, Large B-Cell, Diffuse/chemistry
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/surgery
- Male
- Positron-Emission Tomography
- Tomography, X-Ray Computed
- Treatment Outcome
- Whole Body Imaging
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14
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Jejunojejunal Intussusception as the Initial Presentation of Non-Hodgkin's B-Cell Lymphoma in an Adult Patient: A Case Report and Review of the Literature. Case Rep Surg 2013; 2013:619031. [PMID: 23844307 PMCID: PMC3703414 DOI: 10.1155/2013/619031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 06/06/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction. Intussusception is a rare cause of bowel obstruction in adults and is usually associated with an underlying pathology, benign, or malignant. This is a report of a case of jejunojejunal intussusception secondary to non-Hodgkin's B-cell lymphoma in an adult patient. Case Presentation. A 74-year-old male with no previous significant medical history presented with symptoms of acute intestinal obstruction. A CT scan of the abdomen and pelvis revealed 2 areas of jejunojejunal intussusception, which were surgically managed successfully. Histopathological examination of the specimen revealed the presence of high grade diffuse large B-cell-type non-Hodgkin's lymphoma, and the patient was referred to the oncology team for further management. Discussion. B-cell lymphoma is a rare but well-documented cause of intussusception in adults, with most cases being at the ileocolic region. We present a rare case of jejunojejunal intussusception as the initial presentation of non-Hodgkin's B-cell lymphoma in an adult patient.
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15
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Kobayashi H, Nagai T, Omine K, Sato K, Ozaki K, Suzuki T, Mori M, Muroi K, Yano T, Yamamoto H, Ozawa K. Clinical outcome of non-surgical treatment for primary small intestinal lymphoma diagnosed with double-balloon endoscopy. Leuk Lymphoma 2012; 54:731-6. [DOI: 10.3109/10428194.2012.725850] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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16
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Yang Y, Batth SS, Chen M, Borys D, Phan H, Tang T, Ko YH, Chng WJ, Lim ST, Kim WS, Kwong YL. Enteropathy-associated T cell lymphoma presenting with acute abdominal syndrome: a case report and review of literature. J Gastrointest Surg 2012; 16:1446-9. [PMID: 22528568 DOI: 10.1007/s11605-012-1878-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 03/20/2012] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Enteropathy-associated T cell lymphoma (EATL) is a rare peripheral non-Hodgkin's T cell lymphoma originating from intraepithelial T lymphocytes of the intestines. In general, this condition has a poor prognosis. A common initial presentation of this cancer which is a small intestinal perforation necessitating emergency surgery is of interest to practicing surgeons. The diagnosis is rarely made prior to pathological examination. METHODS We report a case of a 39-year-old African American man who presented with acute abdomen and was found to have a deep necrotic ulcer of the jejunum during exploratory laparotomy. RESULTS Pathological examination and laboratory results demonstrated EATL, type 2, which is not associated with celiac disease. A review of the literature on EATL is also presented.
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Affiliation(s)
- Yifan Yang
- Department of Surgery, University of California, Davis Medical Center, Sacramento, USA.
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17
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Abstract
AIMS The management of primary small bowel and colon lymphoma is controversial. A review of the literature was therefore undertaken to evaluate the evidence for the classification, staging, diagnosis, and treatment of primary small bowel and colon lymphoma and guide management. METHODS A literature search was performed utilising Embase, Medline, and Pubmed and papers were evaluated on an individual basis. RESULTS Consensus opinion favours the WHO classification scheme and the TNM staging systems for primary small bowel and colon lymphoma. CT enteroclysis and barium enterolysis are recommended for the diagnosis of primary small bowel lymphoma and capsule endoscopy and double-balloon enteroscopy maybe useful diagnostic tools. In terms of the diagnosis and staging of primary colonic lymphoma, the evidence is scarce and CT is to be recommended. The mainstay of treatment for primary GI lymphoma is surgery and/or chemotherapy. For primary small bowel and colonic lymphoma, there was no definitive evidence regarding the benefits of either strategy; however, chemotherapy seemed to give a survival benefit over surgery alone for primary small bowel lymphoma and colonic lymphoma was skewed towards surgery plus chemotherapy due to the large number of patients presenting as an emergency. CONCLUSION Published data regarding the management of primary small bowel and colon lymphoma is very limited. Classification and staging should be standardised to enable accurate evaluation of investigations and treatments and a large RCT undertaken to compare chemotherapy and surgery. Currently, we would recommend that management should involve chemotherapy with surgery reserved for those with clinical indication.
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18
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Donnellan F, Moran S, Patchett SE. An incidentaloma at ileal intubation. World J Gastrointest Endosc 2011; 3:228-30. [PMID: 22110839 PMCID: PMC3221956 DOI: 10.4253/wjge.v3.i11.228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 12/14/2010] [Accepted: 04/25/2011] [Indexed: 02/05/2023] Open
Abstract
The authors report the case of a primary small bowel lymphoma discovered incidentally in a 33-year-old male following ileal intubation at colonoscopy. The patient subsequently underwent curative treatment with chemotherapy. This case not only highlights the importance of routine ileoscopy but also the successful use of chemotherapy in a disease for which the optimal treatment modality has not been well characterized.
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Affiliation(s)
- Fergal Donnellan
- Fergal Donnellan, Sarah Moran, Stephen E Patchett, Department of Gastroenterology, Beaumont Hospital, Dublin 1, Ireland
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19
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Wang GB, Xu GL, Luo GY, Shan HB, Li Y, Gao XY, Li JJ, Zhang R. Primary intestinal non-Hodgkin's lymphoma: A clinicopathologic analysis of 81 patients. World J Gastroenterol 2011; 17:4625-31. [PMID: 22147970 PMCID: PMC3226984 DOI: 10.3748/wjg.v17.i41.4625] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 06/20/2011] [Accepted: 06/27/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the clinicopathologic features and the prognosis of primary intestinal lymphoma.
METHODS: Patients were included in the study based on standard diagnostic criteria for primary gastrointestinal lymphoma, and were treated at Sun Yat-sen University Cancer Centre between 1993 and 2008.
RESULTS: The study comprised 81 adults. The most common site was the ileocaecal region. Twenty-two point two percent patients had low-grade B-cell lymphoma. Fifty-one point nine percent patients had high-grade B-cell lymphoma and 25.9% patients had T-cell lymphoma. Most patients had localized disease. There were more patients and more early stage diseases in the latter period, and the origin sites changed. The majority of patients received the combined treatment, and about 20% patients only received nonsurgical therapy. The wverall survival and event-free survival rates after 5 years were 71.6% and 60.9% respectively. The multivariate analysis revealed that small intestine and ileocaecal region localization, B-cell phenotype, and normal lactate dehydrogenase were independent prognostic factors for better patient survival. Surgery based treatment did not improve the survival rate.
CONCLUSION: Refined stratification of the patients according to the prognostic variables may allow individualized treatment. Conservative treatment may be an optimal therapeutic modality for selected patients.
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20
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Kim SJ, Choi CW, Mun YC, Oh SY, Kang HJ, Lee SI, Won JH, Kim MK, Kwon JH, Kim JS, Kwak JY, Kwon JM, Hwang IG, Kim HJ, Lee JH, Oh S, Park KW, Suh C, Kim WS. Multicenter retrospective analysis of 581 patients with primary intestinal non-hodgkin lymphoma from the Consortium for Improving Survival of Lymphoma (CISL). BMC Cancer 2011; 11:321. [PMID: 21798075 PMCID: PMC3160411 DOI: 10.1186/1471-2407-11-321] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 07/29/2011] [Indexed: 12/27/2022] Open
Abstract
Background Primary intestinal non-Hodgkin lymphoma (NHL) is a heterogeneous disease with regard to anatomic and histologic distribution. Thus, analyses focusing on primary intestinal NHL with large number of patients are warranted. Methods We retrospectively analyzed 581 patients from 16 hospitals in Korea for primary intestinal NHL in this retrospective analysis. We compared clinical features and treatment outcomes according to the anatomic site of involvement and histologic subtypes. Results B-cell lymphoma (n = 504, 86.7%) was more frequent than T-cell lymphoma (n = 77, 13.3%). Diffuse large B-cell lymphoma (DLBCL) was the most common subtype (n = 386, 66.4%), and extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) was the second most common subtype (n = 61, 10.5%). B-cell lymphoma mainly presented as localized disease (Lugano stage I/II) while T-cell lymphomas involved multiple intestinal sites. Thus, T-cell lymphoma had more unfavourable characteristics such as advanced stage at diagnosis, and the 5-year overall survival (OS) rate was significantly lower than B-cell lymphoma (28% versus 71%, P < 0.001). B symptoms were relatively uncommon (20.7%), and bone marrow invasion was a rare event (7.4%). The ileocecal region was the most commonly involved site (39.8%), followed by the small (27.9%) and large intestines (21.5%). Patients underwent surgery showed better OS than patients did not (5-year OS rate 77% versus 57%, P < 0.001). However, this beneficial effect of surgery was only statistically significant in patients with B-cell lymphomas (P < 0.001) not in T-cell lymphomas (P = 0.460). The comparison of survival based on the anatomic site of involvement showed that ileocecal regions had a better 5-year overall survival rate (72%) than other sites in consistent with that ileocecal region had higher proportion of patients with DLBCL who underwent surgery. Age > 60 years, performance status ≥ 2, elevated serum lactate dehydrogenase, Lugano stage IV, presence of B symptoms, and T-cell phenotype were independent prognostic factors for survival. Conclusions The survival of patients with ileocecal region involvement was better than that of patients with involvement at other sites, which might be related to histologic distribution, the proportion of tumor stage, and need for surgical resection.
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Affiliation(s)
- Seok Jin Kim
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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21
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Pan SY, Morrison H. Epidemiology of cancer of the small intestine. World J Gastrointest Oncol 2011; 3:33-42. [PMID: 21461167 PMCID: PMC3069308 DOI: 10.4251/wjgo.v3.i3.33] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 02/08/2011] [Accepted: 02/15/2011] [Indexed: 02/05/2023] Open
Abstract
Cancer of the small intestine is very uncommon. There are 4 main histological subtypes: adenocarcinomas, carcinoid tumors, lymphoma and sarcoma. The incidence of small intestine cancer has increased over the past several decades with a four-fold increase for carcinoid tumors, less dramatic rises for adenocarcinoma and lymphoma and stable sarcoma rates. Very little is known about its etiology. An increased risk has been noted for individuals with Crohn’s disease, celiac disease, adenoma, familial adenomatous polyposis and Peutz-Jeghers syndrome. Several behavioral risk factors including consumption of red or smoked meat, saturated fat, obesity and smoking have been suggested. The prognosis for carcinomas of the small intestine cancer is poor (5 years relative survival < 30%), better for lymphomas and sarcomas, and best for carcinoid tumors. There has been no significant change in long-term survival rates for any of the 4 histological subtypes. Currently, with the possible exceptions of obesity and cigarette smoking, there are no established modifiable risk factors which might provide the foundation for a prevention program aimed at reducing the incidence and mortality of cancers of the small intestine. More research with better quality and sufficient statistical power is needed to get better understanding of the etiology and biology of this cancer. In addition, more studies should be done to assess not only exposures of interest, but also host susceptibility.
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Affiliation(s)
- Sai Yi Pan
- Sai Yi Pan, Howard Morrison, Science Integration Division, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Ontario, K1A 0K9, Canada
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22
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Salemis NS, Tsiambas E, Liatsos C, Karameris A, Tsohataridis E. Small bowel intussusception due to a primary non-Hodgkin's lymphoma. An unusual presentation and clinical course. J Gastrointest Cancer 2011; 41:233-7. [PMID: 20411355 DOI: 10.1007/s12029-010-9152-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND/PURPOSE Adult intussusception is a rare clinical entity accounting for 5% of all intussusceptions. Symptoms and signs are often vague and non-specific making a preoperative diagnosis difficult. The purpose of this study is to present a rare case of a jejuno-jejunal intussusception due to primary intestinal non-Hodgkin's lymphoma in a patient with an unusual clinical course. METHODS A 78-year-old man presented with a 1-month history of abdominal pain, nausea, epigastric fullness, and weight loss. Computed tomography scan and ultrasonography findings were suggestive of small bowel intussusception. RESULTS Laparotomy revealed a jejuno-jejunal intussusception caused by a primary B cell non-Hodgkin's lymphoma 20 cm distal to the ligament of Treitz. Resection without prior reduction was performed. The patient refused postoperative adjuvant chemotherapy. Seven months later, he presented with upper gastrointestinal bleeding, and the diagnostic evaluation revealed gastric infiltration of large B cell non-Hodgkin's lymphoma. Despite chemotherapy, he died of disseminated progressive disease 7 months later. CONCLUSIONS Adult jejuno-jejunal intussusception due to primary non-Hodgkin's lymphoma is a rare clinical entity. A high index of suspicion is needed as symptoms and signs are not pathognomonic. Appropriate investigations can lead to a prompt preoperative diagnosis. Resection without prior reduction is the treatment of choice. Our patient's refusal of postoperative adjuvant chemotherapy likely resulted in relapse of the disease in another part of the gastrointestinal tract.
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Affiliation(s)
- Nikolaos S Salemis
- 2nd Department of Surgery, Army Veterans General Hospital, Athens, Greece.
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23
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Chandesris MO, Malamut G, Verkarre V, Meresse B, Macintyre E, Delarue R, Rubio MT, Suarez F, Deau-Fischer B, Cerf-Bensussan N, Brousse N, Cellier C, Hermine O. Enteropathy-associated T-cell lymphoma: a review on clinical presentation, diagnosis, therapeutic strategies and perspectives. ACTA ACUST UNITED AC 2010; 34:590-605. [PMID: 21050687 DOI: 10.1016/j.gcb.2010.09.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Enteropathy-associated T-cell lymphoma (EATL) is a rare complication of celiac disease (<1% of lymphomas) and has a poor prognosis. METHODS International literature review with PubMed search (up to January 2009) of pathophysiological, clinical and therapeutic data. RESULTS EATL is found in patients with a mean age of 59 years, often with a complication that signals its diagnosis. Refractory celiac disease (RCD), equivalent to low-grade intraepithelial T-cell lymphoma, could be an intermediary between celiac disease and high-grade invasive T-cell lymphoma. The median survival is 7 months, with no significant difference between stages; the cumulative 5-year survival is less than 20%. The poor prognosis is determined by disease that has often spread before it is diagnosed (50%), multifocal involvement of the small bowel (50%), poor general health status and undernutrition, and recurrence of complications (infections, perforations, gastrointestinal haemorrhages, occlusions), thus delaying the chemotherapy and contributing to frequent chemotherapy resistance. There is currently no effective and consensual treatment: preventive surgery for complications is controversial, and the results of chemotherapy are disappointing. The classic CHOP protocol (combination of doxorubicin-cyclophosphamide-vincristine-prednisone) does not have satisfactory results and survival remains poor, especially in patients with underlying RCD. High-dose chemotherapy with autotransplantion seems to only improve the prognosis in localised forms. Allogeneic bone marrow transplantation was not evaluated. In all, 1/3 of patients, being unfit for treatment, die before 3 months and half of treated patients stop chemotherapy prematurely due to inefficacy, intolerance and/or complications. CONCLUSION Improvement of the prognosis requires collaboration in order to compose a national cohort, to evaluate new diagnostic and therapeutic strategies and to define prognostic factors.
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Affiliation(s)
- M-O Chandesris
- Service d'hématologie adulte, hôpital Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, université Paris V-René-Descartes, 149, rue de Sèvres, 75743 Paris cedex 15, France
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24
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Majdoub Hassani KI, El Bouhaddouti H, Ousadden A, Ankouz A, Boubou M, Tizniti S, Mazaz K, Taleb KA. Non-Hodgkin's lymphoma revealed by an ilio-colic intussusception in a Moroccan patient: a case report. Pan Afr Med J 2010; 4:11. [PMID: 21119996 PMCID: PMC2984306 DOI: 10.4314/pamj.v4i1.53599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2009] [Accepted: 02/22/2010] [Indexed: 01/24/2023] Open
Abstract
Intussusceptions are rare but well-known causes of the small bowel obstruction in adults and an underlying cause is present in the majority of cases. Lymphoma's involvement of the ileum is one of the rare causes of intussusception. CT is a sensitive examination that diagnoses intussusceptions and provides an excellent pre-operative evaluation including possible extension and dissemination especially in intestinal lymphomas. The treatment is almost always surgical and the pathological study is needed for diagnostic confirmation. Authors present an unusual case of intestinal intussusception due to lymphoma of the terminal part of the ileum in a 49-year-old man. Computed tomography confirmed the diagnosis of intussusception and non-Hodgkin's lymphoma of B-cell was diagnosed by histological examination after surgical treatment. Primary intestinal lymphomas differ from gastric lymphomas in clinical features, treatment, and prognosis. They are not well characterized and the standardized concepts for their clinical diagnosis and management are absent. The aim of this rare observation is to shed light on NHL of the small bowel, its clinical and radiological diagnosis and its treatment especially in forms revealed by intussusceptions in adults.
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25
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Assar AN. An unusual presentation of small bowel lymphoma. J Emerg Med 2009; 41:531-3. [PMID: 19535213 DOI: 10.1016/j.jemermed.2009.04.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2008] [Revised: 02/03/2009] [Accepted: 04/16/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Ahmed N Assar
- Department of General Surgery, Luton & Dunstable Hospital NHS Trust, Luton, Bedfordshire, UK
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26
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Affiliation(s)
- Ahmed N. Assar
- General Surgery, Luton and Dunstable Hospital, Lewsey Road, Luton-LU4 0DZ, Bedfordshire - United Kingdom. E-mail:
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Catassi C, Fabiani E, Corrao G, Barbato M, De Renzo A, Carella AM, Gabrielli A, Leoni P, Carroccio A, Baldassarre M, Bertolani P, Caramaschi P, Sozzi M, Guariso G, Volta U, Corazza GR. Risk of non-Hodgkin lymphoma in celiac disease. JAMA 2002; 287:1413-9. [PMID: 11903028 DOI: 10.1001/jama.287.11.1413] [Citation(s) in RCA: 190] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
CONTEXT Celiac disease is one of the most common lifelong disorders. Non-Hodgkin lymphoma is a possible complication of celiac disease and may lead to a large portion of lymphoma cases. OBJECTIVE To quantify the risk for developing non-Hodgkin lymphoma of any primary site associated with celiac disease. DESIGN AND SETTING Multicenter, case-control study conducted between January 1996 and December 1999 throughout Italy. PATIENTS Cases were older than 20 years (median, 57; range, 20-92 years) with non-Hodgkin lymphoma of any primary site and histological type and were recruited at the time of the diagnosis. Controls were healthy adults (2739 men and 2981 women) from the general population. MAIN OUTCOME MEASURE Positive test result for class A serum antiendomysial antibody. RESULTS Celiac disease was diagnosed in 6 (0.92%) of 653 patients with lymphoma. Of the 6 cases, 3 were of B-cell and 3 were of T-cell origin. Four of 6 cases had lymphoma primarily located in the gut. In the control group, 24 (0.42%) had celiac disease. The odds ratio (adjusted for age and sex) for non-Hodgkin lymphoma of any primary site associated with celiac disease was 3.1 (95% confidence interval [CI], 1.3-7.6), 16.9 (95% CI, 7.4-38.7) for gut lymphoma, and 19.2 (95% CI, 7.9-46.6) for T-cell lymphoma, respectively. The risk for non-Hodgkin lymphoma for the overall population, which was adjusted for age and sex, was 0.63% (95% CI, - 0.12% to 1.37%). CONCLUSION Celiac disease is associated with an increased risk for non-Hodgkin lymphoma, especially of T-cell type and primarily localized in the gut. However, the association does not represent a great enough risk to justify early mass screening for celiac disease.
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Affiliation(s)
- Carlo Catassi
- University of Maryland, Division of Pediatric Gastroenterology and Nutrition, 22 S Greene St, N5W70/Box 140, Baltimore, MD 21201, USA.
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