Korean J Gastroenterol.  2020 Jan;75(1):46-49. 10.4166/kjg.2020.75.1.46.

Adult Ileocolic Intussusception Caused by Diffuse Large B Cell Lymphoma

• Park JW
• Song GA
• Baek DH
• Kim GH
• Lee BE
• Lee MW
• Han SY
• Park YJ
• Park EY

• KMID: 2471139
• DOI: http://doi.org/10.4166/kjg.2020.75.1.46

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.

Keyword

Intussusception; Primary small bowel lymphoma; Diffuse large B cell lymphoma

MeSH Terms

Adult*
Aged
Chemotherapy, Adjuvant
Colon
Constriction, Pathologic
Cyclophosphamide
Diverticulum
Doxorubicin
Female
Gastrointestinal Tract
Hemorrhage
Humans
Intestines
Intussusception*
Lymphoma
Lymphoma, B-Cell*
Lymphoma, Non-Hodgkin
Polyps
Prednisone
Rituximab
Vincristine
Cyclophosphamide
Doxorubicin
Prednisone
Rituximab
Vincristine

Figure

• 

  Fig. 1 (A) Intussusception can be seen (arrow). (B) Asymmetrical and concentric wall thickening called a ‘target sign’ (arrow) was observed and a leading tumor was suspected (asterisk).

• 

  Fig. 2 (A) Approximately 3×3 cm sized solid mass (arrow) originating from terminal ileum causing prolapse of the distal ileum into the ascending colon. (B) Intussusception was reduced by pushing the mass with biopsy forceps, and the mass originated from 20 cm above the ileocecal valve.

• 

  Fig. 3 Approximately 3×3 cm sized solid mass (arrow) was observed at the distal ileum.

• 

  Fig. 4 (A) Several large, pleomorphic, atypical lymphoid cells with abundant mitosis were present (H&E, ×100). (B) The tumor cells were positive for CD20 (CD20, ×400).

Reference

1. Patel S, Eagles N, Thomas P. Jejunal intussusception: a rare cause of an acute abdomen in adults. BMJ Case Rep. 2014; 2014:bcr2013202593.

2. Kim YH, Blake MA, Harisinghani MG, et al. Adult intestinal intussusception: CT appearances and identification of a causative lead point. Radiographics. 2006; 26:733–744.

3. Marinis A, Yiallourou A, Samanides L, et al. Intussusception of the bowel in adults: a review. World J Gastroenterol. 2009; 15:407–411.

4. Kohno S, Ohshima K, Yoneda S, Kodama T, Shirakusa T, Kikuchi M. Clinicopathological analysis of 143 primary malignant lymphomas in the small and large intestines based on the new WHO classification. Histopathology. 2003; 43:135–143.

5. Ghimire P, Wu GY, Zhu L. Primary gastrointestinal lymphoma. World J Gastroenterol. 2011; 17:697–707.

6. Akbulut S. Unusual cause of adult intussusception: diffuse large B-cell non-Hodgkin's lymphoma: a case report and review. Eur Rev Med Pharmacol Sci. 2012; 16:1938–1946.

7. Nam S, Kang J, Park H, Lee KY, Sohn SK. Adult ileocecal intussusception caused by malignant lymphoma. Korean J Clin Oncol. 2014; 10:46–48.

8. Hong KD, Kim J, Ji W, Wexner SD. Adult intussusception: a systematic review and meta-analysis. Tech Coloproctol. 2019; 23:315–324.

9. Yin L, Chen CQ, Peng CH, et al. Primary small-bowel non-Hodgkin's lymphoma: a study of clinical features, pathology, management and prognosis. J Int Med Res. 2007; 35:406–415.

10. Kim YH, Lee JH, Yang SK, et al. Primary colon lymphoma in Korea: a KASID (Korean Association for the Study of Intestinal Diseases) study. Dig Dis Sci. 2005; 50:2243–2247.

11. Majdoub Hassani KI, El Bouhaddouti H, Ousadden A, et al. Non-Hodgkin's lymphoma revealed by an ilio-colic intussusception in a Moroccan patient: a case report. Pan Afr Med J. 2010; 4:11.

12. Myung SJ, Joo KR, Yang SK, et al. Clinicopathologic features of ileocolonic malignant lymphoma: analysis according to colonoscopic classification. Gastrointest Endosc. 2003; 57:343–347.

13. Amr MA, Polites SF, Alzghari M, Onkendi EO, Grotz TE, Zielinski MD. Intussusception in adults and the role of evolving computed tomography technology. Am J Surg. 2015; 209:580–583.

14. Azar T, Berger DL. Adult intussusception. Ann Surg. 1997; 226:134–138.

15. Wang LT, Wu CC, Yu JC, Hsiao CW, Hsu CC, Jao SW. Clinical entity and treatment strategies for adult intussusceptions: 20 years' experience. Dis Colon Rectum. 2007; 50:1941–1949.

16. McKay R. Ileocecal intussusception in an adult: the laparoscopic approach. JSLS. 2006; 10:250–253.