Korean J Gastroenterol.  2015 Apr;65(4):241-245. 10.4166/kjg.2015.65.4.241.

A Case of Small Bowel Diffuse Large B-cell Lymphoma Mimicking Crohn's Disease

• Koo TH
• Choi WJ
• Han SH
• Kim SY
• Lee JH

• KMID: 2373216
• DOI: http://doi.org/10.4166/kjg.2015.65.4.241

Abstract

A 66-year-old male with dyspepsia and weight loss was referred to our hospital for evaluation. On laboratory examination, anti-saccharomyces cerevisiae (ASCA)-IgA was positive and iron deficiency anemia was present. PET/CT and abdominal CT scan images showed multiple small bowel segmental wall thickening and inflammation. Capsule endoscopy images showed multiple small bowel ulcerative lesions with exudates. Based on laboratory test results and imaging studies, the patient was diagnosed with Crohn's disease and treated with prednisolone and 5-aminosalicylic acid (5-ASA). However, the patient underwent second operation due to small bowel perforation within 2 month after initiation of treatment. Pathology report of the resected specimen was compatible to primary small bowel diffuse large B cell lymphoma and pertinent treatment was given to the patient after recovery. Herein, we describe a case of primary small bowel diffuse large B cell lymphoma that was mistaken for Crohn's disease.

Keyword

Crohn disease; Intestinal; Diffuse large B-cell lymphoma

MeSH Terms

Aged
Antibodies/blood
Antineoplastic Combined Chemotherapy Protocols/therapeutic use
Capsule Endoscopy
Crohn Disease/diagnosis/drug therapy
Diagnostic Errors
Humans
Immunoglobulin A/blood
Intestinal Perforation/surgery
Lymphoma, Large B-Cell, Diffuse/*diagnosis/drug therapy/pathology
Male
Mesalamine/therapeutic use
Positron-Emission Tomography
Saccharomyces cerevisiae/immunology
Tomography, X-Ray Computed
Antibodies
Immunoglobulin A
Mesalamine

Figure

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  Fig. 1. (A) Conventional CT scan images show wall thickening and mucosal hyperenhancement on multiple segments of jejunum (arrows). (B) PET/CT scan images show increased uptake on multiple segments of jejunum.

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  Fig. 2. Capsule endoscopy images show multiple ulcers on jejunum.

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  Fig. 3. Gross and microscopic findings. (A) The resected jejunum shows multiple ulcers with perforations. (B) Microscopically, ill-defined ulcerative mass is seen throughout the jejunal wall (H&E, ×16). (C) Immunohistochemistry stain (CD20, ×100). CD20 is expressed in the tumor cells. (D) Large atypical lymphoid cell infiltration with non-cohesive pattern is observed on high-power field magnification (H&E, ×200).

Reference

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