Pediatr Gastroenterol Hepatol Nutr.  2019 Nov;22(6):571-575. 10.5223/pghn.2019.22.6.571.

Anaplastic Large Cell Lymphoma of the Duodenum in a Teenage Girl: Misdiagnosed as an Intramural Duodenal Hematoma

• Sriphongphankul H
• Tanpowpong P
• Ruangwattanapaisarn N
• Thirapattaraphan C
• Treepongkaruna S

• KMID: 2462097
• DOI: http://doi.org/10.5223/pghn.2019.22.6.571

Abstract

We report a case of a 13-year-old girl who presented with a 2-month history of intermittent abdominal pain. Laboratory examination showed hepatitis and pancreatitis. Because of persistent vomiting, computed tomography (CT) was performed, which revealed a circumferential soft tissue density in the duodenal wall, causing partial obstruction. Supportive therapy failed. Repeat CT showed no significant change from the initial study. The patient underwent upper endoscopy, which revealed a mass in the second portion of the duodenum, which occluded most parts of the lumen. The histopathological finding was consistent with an anaplastic large cell lymphoma, a rare form of small bowel neoplasm. After the third course of chemotherapy, complete resolution of the mass was noted, and her symptoms were relieved.

Keyword

Hepatitis; Pancreatitis; Vomiting; Duodenal mass

MeSH Terms

Abdominal Pain
Adolescent
Drug Therapy
Duodenum*
Endoscopy
Female*
Hematoma*
Hepatitis
Humans
Lymphoma, Large-Cell, Anaplastic*
Pancreatitis
Vomiting

Figure

• 

  Fig. 1 (A) Computed tomography revealed circumferential soft tissue density (*) along the wall of the second and third parts of the duodenum with proximal bowel dilatation and upstream dilatation of both common bile (ⱡ) and pancreatic ducts. (B) The follow-up scan showed no significant change in circumferential soft tissue density (*) after 17 days. (C) Complete resolution of the mass within 4 months after the third course of chemotherapy.

• 

  Fig. 2 (A, B) Endoscopic examination revealed that mass (*) at the second part of the duodenum occluded approximately 80% of the lumen without ulceration or exudates. (C, D) Complete patency of the similar area of the duodenum 4 weeks after the completion of chemotherapy.

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