Korean J Gastroenterol.  2019 Nov;74(5):291-294. 10.4166/kjg.2019.74.5.291.

Distal Ileal Lymphoma Presenting Ileocecal Intussusception with Spontaneous Reduction

Affiliations
  • 1Division of Gastroenterology, Department of Internal Medicine, Dong-A University Hospital, Busan, Korea. jh2002@dau.ac.kr
  • 2Department of Pathology, Dong-A University Hospital, Busan, Korea.

Abstract

Intussusception is a rare disease in adults. A demonstrable etiology is found in approximately 85% of all cases, and approximately 40% of them are caused by malignant tumors. A 65-year-old patient visited the outpatient department with mild abdominal pain without other symptoms. The initial laboratory test and simple X-ray showed normal findings. CT revealed intussusception in the ileocecal area. The initial colonoscopic biopsy revealed atypical cells. Follow up colonoscopy showed spontaneous reduction of the intussusception. Diffuse large B-cell lymphoma was suspected in the second colonoscopic biopsy. An elective operation was performed. This case reports a case of a spontaneous reduction of adult intussusception with a brief review of literature.

Keyword

Immunoproliferative small intestinal disease; Intussusception; Colonoscopy

MeSH Terms

Abdominal Pain
Adult
Aged
Biopsy
Colonoscopy
Follow-Up Studies
Humans
Immunoproliferative Small Intestinal Disease
Intussusception*
Lymphoma*
Lymphoma, B-Cell
Outpatients
Rare Diseases

Figure

  • Fig. 1 (A) A mass like lesion with mild contrast enhancement (white arrow) is observed in the cecum. The proximal ileocecal valve shows a crescent shape. (B) Enlarged lymph node (white arrow) is observed adjacent to the ileocecal area.

  • Fig. 2 (A) The normal cecum and the intussuscepted ileocecal valve are observed like a mass. The upper part of the intussuscepted region (white arrow) was firm and showed mucosal erythema. At the lower part, a normal ileal mucosa is observed. (B) Other side view of the intussuscepted lesion. (C, D) Biopsies were done at the marked area (white arrows).

  • Fig. 3 (A) The normal cecum and the ileocecal valve are observed. (B–D) Two fungating masses were observed (B, C: proximal terminal ileum; D: distal terminal ileum).

  • Fig. 4 (A) Micrograph of the ileal mass. The submucosal layer is invaded by atypical cells (H&E, ×20). (B) The nuclei of atypical cells are three times larger than normal lymphocytes and scattered diffusely (H&E, ×200). (C) Tumor cells can be diagnosed as a diffuse large B-cell lymphoma when the findings of (B) demonstrate a strong positive for CD20 immunostaining, a B-cell marker (CD20 immunohistochemical, ×200). (D) Tumor cells are positive for CD10 and correspond to the germinal center B type according to the Hans classification (CD20 immunohistochemical, ×20).


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