Lymphoma in an ileostomy

Abstract

Lymphoma developing in an ileostomy is an extremely rare complication. The presentation is similar to the commoner, yet still rare, adenocarcinoma but the staging and management of the condition differs.A 78 year old man was referred to the surgical outpatient clinic by the stoma care clinical nurse specialist. He was having increasing difficulties with his long standing right iliac fossa end ileostomy that had been created 20 years earlier for ulcerative colitis. He noticed that it was functioning but prolapsed, extending to approximately 10 cm from the skin surface. It was very hard, swollen with a diameter of 6.4 cm, with the tip appearing bruised and black, stenosed, and bleeding to the touch. These changes had occurred over a six month period and been associated with several episodes of bleeding. It was painless but he was having great difficulty in obtaining a satisfactory seal with the stoma appliances. His weight was steady and his appetite good. He was a hypertensive on treatment and was otherwise well.Examination confirmed the above findings of a swollen, necrotic, and stenosed stoma (see fig 1) and also revealed two skin deposits adjacent to the stoma and a large parastomal hernia. A clinical diagnosis of a malignant change in an ileostomy was made and after discussion with the patient, a decision to undertake an en-bloc excision and refashioning of the stoma was made. A preoperative biopsy was not carried out as it was felt that it would not change the above management plan.A midline laparotomy was carried out to clinically stage the disease. No obvious mesenteric or para-aortic nodal enlargement was detected. The liver and spleen were impalpable due to adhesions. The ileostomy was excised en-bloc with the abdominal wall through a transverse elliptical incision. A new end ileostomy was fashioned in the left iliac fossa.Histology revealed a B-cell non-Hodgkins lymphoma of the ileum. The tumour appeared to have been completely excised.Standard staging tests showed that the tumour appeared to be localised. In view of its large size and grade II histology and hence a high probability of occult disease, chemotherapy was offered with PACEBO (prednisolone, Adriamycin, cyclophosphamide, etoposide, bleomycin, and oncovin), an eight week protocol discussed by the British National Lymphoma Investigation for elderly patients with non-Hodgkin's lymphoma.

Primary Mucinous Adenocarcinoma in an Ileostomy with Adjacent Skin Invasion: A Late Complication of Surgery for Ulcerative Colitis

“…The most common carcinoma being reported in previous literature was mucin-secreting adenocarcinoma [6]. An unusual case of lymphoma has also been reported [12].…”

Primary diffuse large B‐cell lymphoma of the ileal conduit created after radical cystectomy

“…Moreover, Ota et al . reported a case of DLBCL of the ileal neobladder, in which the patient had no medical history of inflammatory bowel disease or immunosuppressive therapy; they mentioned that the cause of DLBCL in their case might be associated with chronic infection . The cause of DLBCL in our case was unclear because the patient had a past medical history of esophageal cancer, stomach cancer, and bladder cancer but did not use chemotherapy or have diseases that lead to immunodeficiencies.…”

Adenocarcinoma of an Ileostomy in a Case of Hirschprung’s Disease with Retroviral Disease

“…Suarez et al estimated the incidence of ileostomy carcinomas in Britain to be 2-4 per 1000 ileostomies 5 . One case of lymphoma in ileostomy has also been reported 6 . Similarly, 2 cases of melanoma and 4 cases of squamous cell carcinoma at an ileostomy site have been reported.…”