Clinical diagnosis
Case 4
【Progress】
The patient received an emergent abdominal open surgery. The tumors of the small intestine and several lymph-nodes of the mesentery were taken out. The histological examination of the resected specimen during operation revealed malignant lymphoma. Thereafter, the patient was scheduled to undergo chemotherapy.
【Discussion】
According to the report of Ciccarelli O et al., of the 51 malignant patients of the small bowel in their hospital at the time of 1969-1983, 20 had neuroendocrine tumors, 17 had adenocarcinoma, 8 had leiomyosarcoma, and 6 had malignant lymphoma (1). Namely, malignant lymphoma is the fourth rank of the malignant tumors of the small bowel.
Meanwhile, according to the retrospective review article of 19 patients (age range 41-81 years) on perforation due to small bowel malignancy, the histology included; malignant lymphoma 7 patients; leiomyosarcoma 2 patients; gastrointestinal stromal tumor 1 patient; adenocarcinoma 1 patient: unknown primary tumors 4 patients; metastatic carcinomas 4 patients ( 2 from lung cancer, 1 from hypopharynx, 1 from uterine cervix) (2). Then, malignant lymphoma is the most of the perforation malignant bowel diseases.
Perforation, bleeding, and ileus are known complications of small intestinal lymphoma and can occur either at diagnosis or during the course of treatment (3-5). In our case aged 82-year-old which was the highest age of the reported cases, appetite loss and fever occurred initially and followed by perforation and ileus,
The prognosis of malignant lymphoma of the small bowel was poor: two-year survival rate 10-27 % (3-5). Early diagnosis using radiographic studies and multi-disciplinary therapy was reported to be crucial to overcome this disease (5). In our case, CT conducted at admission, showed the multi-centric occurrence of the tumor causing ileus, peritonitis and free air with the swollen mesenteric lymphnodes, yielding to the diagnosis of malignant lymphoma. After surgical resection of the tumors and lymphnodes, chemotherapy is scheduled in order to repress the tumor growing.
【Summary】
An eighty one-year-old male came to our hospital suffering from appetite loss, diarrhea and fever. CT depicted the tumors of small bowel causing ileus, perforation and peritonitis and the swollen mesenteric lymphnodes.. Histological examination revealed malignant lymphoma. Of the malignant tumors of small bowels with perforation, the incidence of malignant lymphoma was the most in the past literatures.
【References】
1.Ciccarelli O et al. Primary malignant tumors of the small bowel - The Hartford Hospital experience, 1969-1983. Am J Surg. 198;153:350-354.
2.Chao TC et al. Perforation through small bowel malignant tumors.J Gastrointest Surg. 2005;9:430-435.
3.Sakakura C et al. Bowel perforation during chemotherapy for non-hodgkin's lymphoma.Hepatogastroenterology. 1999 ;46:3175-3177.
4.Dughayli MS et al. Synchronous perforation of non-Hodgkin's lymphoma of the small intestine and colon: a case report. J Gastrointest Surg. 2005 ;9:430-435.
5.Ara C et al. Spontaneous intestinal perforation due to non-Hodgkin's lymphoma: evaluation of eight cases. Dig Dis Sci. 2007; 52:1752-1756.
2016.04.27
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