Sharon Slomovich, MD1, Mahnoor Khan, DO2, Neal Shah, DO1, Frank Gress, MD, MBA, FACG3 1Mount Sinai South Nassau, Oceanside, NY; 2ISMMS Mt. Sinai South Nassau, Oceanside, NY; 3Icahn School of Medicine at Mount Sinai (ISMMS), Mount Sinai South Nassau (MSSN), Oceanside, NY
Introduction: Lymphoma originating from the gastrointestinal tract is rare and accounts for only 1-4% of malignancies arising in the stomach, small intestine or colon. Patients often present with nonspecific symptoms and despite the application of advanced imaging techniques, diagnosis can be challenging. We present a case series of two patients with ambiguous gastrointestinal symptoms and a subsequent diagnosis of primary intestinal lymphoma.
Case Description/Methods: A 43-year-old male with a medical history of sarcoidosis presented with three months of periumbilical pain and a 30-pound, unintentional weight loss. Physical exam, laboratory investigation, esophagogastroduodenoscopy (EGD), colonoscopy and video capsule endoscopy (VCE) were unremarkable. CT abdomen and pelvis revealed a partial small bowel obstruction (Figure 1a). A subsequent small bowel enteroscopy (SBE) demonstrated a nonspecific inflammation of the ileum. Additionally, a CT enterography disclosed the presence of a stricture in the mid-ileum. Given the unclear etiology of the pathology three months following presentation, small bowel resection was performed and pathology revealed a diffuse large B-cell lymphoma.
A 55-year-old female with a medical history of Lynch syndrome presented with one month of abdominal pain, vomiting and a five-pound, unintentional weight loss. The physical exam and laboratory investigation were normal. Magnetic resonance enterography showed a 6 cm proximal ileal segment with irregular concentric wall thickening. SBE revealed nodular ileal mucosa with ulceration in the mid-ileum (Figure 1b). Biopsies demonstrated low-grade follicular lymphoma and this was demonstrated four months after presentation.
Discussion: Presenting symptoms of primary intestinal lymphoma are vague and commonly include abdominal pain, hematochezia, melena or changes in bowel habits. Radiological findings are often nonspecific and may present a challenge in distinguishing lymphoma from other lesions, benign or malignant. While VCE and small bowel enteroscopy with biopsies have improved the identification of small intestinal pathologies, a nonspecific clinical presentation can result in delayed intervention. Thus, diagnosing primary intestinal lymphoma remains a challenge and further research is needed to provide insight on the best practice for its diagnosis and treatment.
Figure: Figure 1a: Computed tomography enterography showing mild hyperenhancement in the narrowed region (red arrow). Figure 1b: Small bowel enteroscopy demonstrating ulcerated nodular mucosa in the ileum.
Disclosures:
Sharon Slomovich indicated no relevant financial relationships.
Mahnoor Khan indicated no relevant financial relationships.
Neal Shah indicated no relevant financial relationships.
Frank Gress: Salvo Health – Advisory Committee/Board Member, Stock Options.
Sharon Slomovich, MD1, Mahnoor Khan, DO2, Neal Shah, DO1, Frank Gress, MD, MBA, FACG3. P4119 - Small Bowel Lymphoma: A Case Series, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
