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Chronic ileocolic intussusception due to transmural infiltration of diffuse large B cell lymphoma in a 14-year-old boy: a case report.

Saka R, Sasaki T, Matsuda I, Nose S, Onishi M, Fujino T, Shimomura H, Otsuka Y, Kajimoto N, Hirota S, Oue T - Springerplus (2015)

Bottom Line: The patient had been suffering from anorexia and intermittent abdominal pain for 5 weeks, during which his body weight decreased by around 7 kg.Since hydrostatic reduction was unsuccessful, laparotomy was performed, which showed unreducible ileocolic intussusception with a marked edematous ileum and mesentery.Ileocecal resection without lymph node dissection was carried out, and a histological examination of the resected specimen revealed the transmural infiltration of diffuse large B-cell lymphoma of the terminal ileum.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 6638501 Japan.

ABSTRACT
Chronic intussusception, defined as intussusception continuing over 14 days, is rare in children. We herein report a case of chronic ileocolic intussusception caused by the transmural infiltration of diffuse large B cell lymphoma in a 14-year-old boy. The patient had been suffering from anorexia and intermittent abdominal pain for 5 weeks, during which his body weight decreased by around 7 kg. Upon admission to our hospital, ultrasonography and enhanced computed tomography (CT) of the abdomen showed ileocolic intussusception. A retrospective examination of abdominal CT led us to suspect that the intussusception had initially appeared 5 weeks before admission, presumably coinciding with the beginning of the patient's abdominal symptoms. Since hydrostatic reduction was unsuccessful, laparotomy was performed, which showed unreducible ileocolic intussusception with a marked edematous ileum and mesentery. Ileocecal resection without lymph node dissection was carried out, and a histological examination of the resected specimen revealed the transmural infiltration of diffuse large B-cell lymphoma of the terminal ileum. The patient's postoperative course was uneventful, and adjuvant chemotherapy was administered. This case illustrates the diagnostic challenges of confirming 'chronic' intussusception in older children.

No MeSH data available.


Related in: MedlinePlus

Representative histological images of the tumor cells in the resected specimen. a Hematoxylin–eosin (HE) stain. b–d Immunohistochemistry. b CD20. c BCL2. d TdT. Positive cells stained brown on immunohistochemistry. Original magnification ×400. Bar 50 μm.
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Fig5: Representative histological images of the tumor cells in the resected specimen. a Hematoxylin–eosin (HE) stain. b–d Immunohistochemistry. b CD20. c BCL2. d TdT. Positive cells stained brown on immunohistochemistry. Original magnification ×400. Bar 50 μm.

Mentions: In the resected specimen, a 3 cm submucosal firm mass was found 2 cm oral from the ileocecal valve (Figure 4). The mucosa of the terminal ileum was edematous and partially erosive. Histologically, the ileocecal mass was composed of the transmural diffuse proliferation of medium- to large-sized lymphoid cells (Figure 5a). Immunohistochemistry revealed that the tumor cells were positive for CD20 (Figure 5b), CD79a (data not shown) and Bcl-2 (Figure 5c). The tumor cells also showed positive immunostaining for CD10 and Bcl-6 in the majority and c-myc in part. In contrast, immunostaining for CD3 (data not shown), TdT (Figure 4d), CD34, CD23 and cyclin D1 was negative (data not shown). Around 70% of the tumor cells were positive for Ki-67. These findings led to a diagnosis of diffuse large B-cell lymphoma (DLBCL) of the terminal ileum. There were no obvious metastatic lesions on the postoperative FDG PET/CT scans. According to the Murphy staging system, we classified the patient as having stage II disease.Figure 4


Chronic ileocolic intussusception due to transmural infiltration of diffuse large B cell lymphoma in a 14-year-old boy: a case report.

Saka R, Sasaki T, Matsuda I, Nose S, Onishi M, Fujino T, Shimomura H, Otsuka Y, Kajimoto N, Hirota S, Oue T - Springerplus (2015)

Representative histological images of the tumor cells in the resected specimen. a Hematoxylin–eosin (HE) stain. b–d Immunohistochemistry. b CD20. c BCL2. d TdT. Positive cells stained brown on immunohistochemistry. Original magnification ×400. Bar 50 μm.
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508281&req=5

Fig5: Representative histological images of the tumor cells in the resected specimen. a Hematoxylin–eosin (HE) stain. b–d Immunohistochemistry. b CD20. c BCL2. d TdT. Positive cells stained brown on immunohistochemistry. Original magnification ×400. Bar 50 μm.
Mentions: In the resected specimen, a 3 cm submucosal firm mass was found 2 cm oral from the ileocecal valve (Figure 4). The mucosa of the terminal ileum was edematous and partially erosive. Histologically, the ileocecal mass was composed of the transmural diffuse proliferation of medium- to large-sized lymphoid cells (Figure 5a). Immunohistochemistry revealed that the tumor cells were positive for CD20 (Figure 5b), CD79a (data not shown) and Bcl-2 (Figure 5c). The tumor cells also showed positive immunostaining for CD10 and Bcl-6 in the majority and c-myc in part. In contrast, immunostaining for CD3 (data not shown), TdT (Figure 4d), CD34, CD23 and cyclin D1 was negative (data not shown). Around 70% of the tumor cells were positive for Ki-67. These findings led to a diagnosis of diffuse large B-cell lymphoma (DLBCL) of the terminal ileum. There were no obvious metastatic lesions on the postoperative FDG PET/CT scans. According to the Murphy staging system, we classified the patient as having stage II disease.Figure 4

Bottom Line: The patient had been suffering from anorexia and intermittent abdominal pain for 5 weeks, during which his body weight decreased by around 7 kg.Since hydrostatic reduction was unsuccessful, laparotomy was performed, which showed unreducible ileocolic intussusception with a marked edematous ileum and mesentery.Ileocecal resection without lymph node dissection was carried out, and a histological examination of the resected specimen revealed the transmural infiltration of diffuse large B-cell lymphoma of the terminal ileum.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 6638501 Japan.

ABSTRACT
Chronic intussusception, defined as intussusception continuing over 14 days, is rare in children. We herein report a case of chronic ileocolic intussusception caused by the transmural infiltration of diffuse large B cell lymphoma in a 14-year-old boy. The patient had been suffering from anorexia and intermittent abdominal pain for 5 weeks, during which his body weight decreased by around 7 kg. Upon admission to our hospital, ultrasonography and enhanced computed tomography (CT) of the abdomen showed ileocolic intussusception. A retrospective examination of abdominal CT led us to suspect that the intussusception had initially appeared 5 weeks before admission, presumably coinciding with the beginning of the patient's abdominal symptoms. Since hydrostatic reduction was unsuccessful, laparotomy was performed, which showed unreducible ileocolic intussusception with a marked edematous ileum and mesentery. Ileocecal resection without lymph node dissection was carried out, and a histological examination of the resected specimen revealed the transmural infiltration of diffuse large B-cell lymphoma of the terminal ileum. The patient's postoperative course was uneventful, and adjuvant chemotherapy was administered. This case illustrates the diagnostic challenges of confirming 'chronic' intussusception in older children.

No MeSH data available.


Related in: MedlinePlus