Non-hodgkin Lymphoma of Lymphoid Tissue Associated with Extranodal Mucosa of the Cecum and Acute Appendicitis. Report of a Case

Abstract

Objective: Presentation of an acute appendicitis and non-Hodgkin lymphoma of lymphoid tissue associated with extranodal mucosa from the cecum clinical case. Introduction: The cecal appendix can be affected by Non-Hodgkin Lymphomas (NHL) by extension of the neoplasm; however primary appendicular lymphoproliferative processes are uncommon. The NHL of Mucosal-Associated Lymphoid Tissue (MALT) is exceptional. To establish the diagnosis of MALT, a morphological, molecular and immunohistochemical diagnosis is required, including molecular techniques that reflect B cell clones, PCR analysis or the identification of chromosomal abnormalities. Methods: 40 year old male, with 15 days of evolution of abdominal pain located in Right Lower Quadrant (RLQ) and associated symptoms like decreased appetite, nausea, and adynamia, who was firstly diagnosticated as an urinary tract infection treated as outpatient; upon his readmission, he was performed CT scan evidencing mesenteric panniculitis and thickening of the appendicular wall; he was surgically intervened finding edematous and congestive vermiform appendix with lower third perforation, and indurated cecum with 2 cm perforation from the appendicular base, performing right hemicolectomy with ileo-transverse mechanical anastomosis; he was discharged home 7 days after the postoperative period; the histopathological study and immunohistochemistry panel was compatible with MALT-type lymphoma, with lesion-free edges. Extension CT scans with no evidence of distant disease. He was sent to oncology for follow-up. Conclusion: It is important to get an established diagnosis in this rare pathology with molecular techniques and not only with histopathological cuts, since 30% of patients relapse.