Multiple Burkit's small bowel lymphoma complicated by acute intestinal obstruction (a clinical case report and review of publications)

Abstract

Small bowel lymphoma is a comparatively rare disease. Usually no typical nor explicit symptoms are determined during its course and the first manifestation can be noticed when a complication occurs. We report a case of a 40 year old man, operated on for acute obstruction of small bowel. Intraoperatively 17 tumor formations were found along the small bowel, d 3 to 5 cm, some of which had caused almost tight obstruction of the small bowel lumen. In addition, small bowel invagination was determined in 3 places. A subtotal resection of the small bowel was performed followed by a smooth postoperative period and then chemotherapy after the patient was discharged from the surgery.

Burkitt's Lymphoma Causing Intussusception in Adults:Report of two Cases and Review of the Literature

“…The clinical symptoms are various and non-typical. abdominal pain of various character and intensity, vomit, inexplicable weight loss (approximately 39 % of all the patients), torpidity, apathy, permanent fatigue, night perspiration, subfertility, sporadical gastrointestinal bleeding [24] . The combination of the above mentioned symptoms is reported in 10-40% of the cases.…”

“…In addition symptoms could change according to complications. in case of erosion of a large vessel the symptoms of acute gastrointestinal hemorrhage, in cases of small bowel perforation symptoms of acute peritonitis, in cases of small bowel lumen obstruction symptoms of acute intestinal obstruction could appear [24] . Intussusception caused by Burkitt's lymphoma, as a cause of acute abdomen, is rare, with symptoms which often mislead and make diagnosis more difficult [17,25] .…”

“…It must be kept in mind that CAT has limited possibilities in diagnostics of small lymphomas <0.5 cm or diffusive infiltration of the intestinal segment. The manifestation is presented by a broad range of signs: multiple intralumenal polypoid formations, broad-base ulcers, aneurismal dilatations, narrowed lumen with mycosis destruction, large excavations [24] . CAT is currently considered as the most sensitive radiologic method to confirm intussusception, with a reported diagnostic accuracy of 58%-100% [2] .…”

“…In cases of impossibility for resection or extensive disease combined chemotherapy and irradiation is used to inhibit the risk of reoccurrence. In some cases marrow transplantation is performed [24,27] . Lymph tissue may be found in small bowel in the deep layer of mucosis or submucosis 24.…”

“…The disease may spread lengthwise or crosswise affecting the mucous (tumorous or multinodular type) or may spread all over the intestinal wall (infiltrative type). Its progress into serosa affecting the intestinal meshes and mesenterium constitutes the extralumen form [24] . The tumor cells exhibit a high mitotic rate and a high degree of apoptosis with diffuse sheets and starry-sky pattern imparted by numerous benign histiocytes with phagocytosis of apoptotic cellular debris.…”