Primary small intestinal lymphoma: A rare cause of small intestinal perforation

摘要

A 78-year-old woman presented to the emergency department with epigastricpainfor1 day.Physical examination revealedabdom- inal tenderness, rebound tenderness and muscle tension. Laboratory results indicated blood routine test, liver and renal function test and electrolyte were normal, but C-reactive protein (123.0 mg/L; refer- ence, 0e10.0 mg/L) and procalcitonin (1.450 ng/mL; reference, <0.05 ng/mL) were significantly increased. Computed tomography of the abdomen showed free gas of abdomen cavity (Fig. 1a), asym- metric thickening of intestinal wall and multiple retroperitoneal enlargedlymphnodes(Fig.1b).Adiagnosisofacutegeneralizedperi- tonitis caused by small intestinal perforation was considered. Then, emergency exploratory laparotomy was performed for this patient, intraoperatively, we found a ruptured tumor of small intestine with 30 cm distant to ileocecus, multiple enlarged lymph nodes in small intestine mesentery and retroperitoneum. She finally under- went partial resection of small intestine and lymph nodes excision. Histologic examination revealed diffusive infiltration of atypical lymphoid cells in the tumor (Fig. 2a). Immunohistochemical analysis indicated that the tumor cells were positive for CD20, CD79a, PAX-5, BCL-2,MUM-1(Fig.2bef).Finally,thediagnosisofdiffuselargeB-cell non-Hodgkin's lymphoma was confirmed. The patient discharged uneventfully on postoperative day 12 and transferred to hematology for chemotherapy.