Shaina Ailawadi, MD1, Trevor Colwell, DO2, James Lamb, MD2 1University Hospitals, Cleveland, OH; 2Wright State University, Dayton, OH
Introduction: Mucosa-associated lymphoid tissue (MALT) lymphomas are rare, accounting for 7% of all Non-Hodgkin Lymphomas. Unlike gastric MALT lymphomas, which have been well-characterized, intestinal MALT lymphoma comprises only 2.5% of the MALT lymphomas, with jejunal tumors being one of the rarest locations. A paucity of case reports has characterized jejunal tumor findings on double-balloon enteroscopy as small erosions, polypoid lesions, a single stricture, or diffuse erythema. Our peculiar case is of a patient with two distinct jejunal MALT lymphoma masses presenting with a partial small bowel obstruction.
Case Description/Methods: A 67-year-old male presented with several days of vomiting, diarrhea, left lower quadrant abdominal pain, and anorexia. The patient had a history notable for iron deficiency anemia and a positive fecal immunochemical test two years prior to presentation, with no previous colonoscopy. Computed tomography of the abdomen showed markedly large bilateral inguinal hernias containing short segments of distal small bowel and sigmoid colon, dilated segments of small bowel in the left lower abdomen, several areas of small bowel wall thickening measuring up to 3.8cm, and irregularly enlarged mesenteric lymph nodes highly concerning for malignancy. Exploratory laparotomy was significant for two separate masses in the jejunum measuring 2.1 cm and 3.8 cm and the masses were resected during the surgery. Upon further pathological analysis, the tumors were positive for BCL-2 and CD20 signifying MALT lymphoma. Post-operatively the patient resumed a normal diet and had resolution of symptoms. Since the jejunal mass resection alleviated the patient’s small bowel obstruction, the hernias were shown to not be a cause of small bowel obstruction during admission.
Discussion: Unlike gastric MALT lymphoma, small intestinal MALT lymphomas, specifically in the jejunum, are not well characterized and are seldom reported in the literature. We have found one similar case to our patient’s presentationdemonstrating small intestinal marginal zone MALT lymphoma, but it presented as a single stricture lesion with superficial ulceration causing a small bowel obstruction. In our case, the patient had two isolated masses positive for marginal zone MALT lymphoma resulting in a small bowel obstruction. Although rare, it is advised that providers keep small intestinal tumors as part of their differential diagnoses when considering causes of small bowel obstruction.
Figure: Figure: CT-Abdomen Showing Two Jejunal Masses A) CT-abdomen imaging significant for jejunal mass A measuring 20.7mm (arrow) with associated bilateral inguinal hernias. B) CT-abdomen imaging showing jejunal mass B measuring 37.5mm (rectangle).
Shaina Ailawadi indicated no relevant financial relationships.
Trevor Colwell indicated no relevant financial relationships.
James Lamb indicated no relevant financial relationships.
Shaina Ailawadi, MD1, Trevor Colwell, DO2, James Lamb, MD2. P4139 - Double Trouble: A Rare Spotting of Jejunal MALT Lymphoma, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.