An unusual and malignant intussusception in a child
© The Author(s). 2016
Received: 27 June 2016
Accepted: 25 July 2016
Published: 1 August 2016
Intussusception is a common cause of bowel obstruction in the pediatric population. Malignant lesions account for up to 30 % of all cases of intussusception in the small intestine. We herein report an interesting case of ileo-colic intussusception caused by diffuse large B-cell lymphoma, in a child. The patient underwent laparoscopic right hemicolectomy. Pathologic evaluation revealed a diffuse large B-cell lymphoma.
In cases of intussusception, especially in the older age group of children, a high index of suspicion for malignant lymphoma of the bowel should be observed.
KeywordsMalignant tumour Small intestine Bowel obstruction Surgery Child
Intussusception, defined as the telescoping of a segment of the gastrointestinal tract into an adjacent one, is often seen in paediatric age . Gastrointestinal tumours, especially if they occur in the large bowel, cause intestinal intussusception in 63–68 % of cases . Intussusception caused by diffuse large B-cell lymphoma (DLBCL), as a cause of acute abdomen, is rare, and, often, intussusception represents the first clinical sign, leading, potentially, to disease detection at an early stage .
Primary malignant tumours of the small intestine are very rare, accounting for less than 2 % of all gastrointestinal malignancies . Lymphoma constitutes 15–20 % of all small intestine neoplasms . In particular, DLBCL, the most common form of non-Hodgkin lymphoma (NHL), is a heterogeneous entity rarely causing acute obstructive symptoms and intussusceptions . Intestinal involvement of NHL has been correlated to increased frequency of abdominal symptoms resulting in an earlier diagnosis. It was found that the invasion depth of the tumour is significantly associated with patient survival . DLBCL-patients initially undergo chemotherapy rather than surgery. Therefore, the relationship between surgery treatment and prognosis has not previously been reported. The importance of resection of the bowel containing even the smallest of lesions, along with removal of regional lymph nodes, is further stressed . Moreover, a multicenter study found that primary surgical resection was associated with a favourable prognosis in cases of intestinal DLBCL, encouraging surgical resection as primary treatment . Conversely, an increased risk of gastric adenocarcinoma after treatment of primary gastric lymphoma has been also reported, especially of diffuse large B-cell lymphoma . Finally, there is no consensus on the optimal treatment against primary gastrointestinal DLBC [5, 6].
In conclusion, we describe a pediatric case of large B-cell lymphoma causing an ileo-colic intussusception. In cases of intussusception, especially in the older age group of children, a high index of suspicion for malignant lymphoma of the bowel, including DLBCL should be observed.
CT, computed tomography; DLBCL, diffuse large B-cell lymphoma; NHL, non-hodgkin lymphoma
The authors are grateful to the patient and his family for their support for our article.
The authors declare that they have no sources of funding.
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All clinical data and supporting materials concerning the manuscript are available in case of Editorial request.
GD Study conception and design of the manuscript. LM, SM Writing up of first draft of the paper. GS, DI Conceived the paper. SA, PI Helped draft the manuscript. CS Critical revision of the article. CR Critical revision of the article. EG Approved final manuscript. All authors read and approved the final manuscript.
The authors declare that they have no competing interests.
Ethics approval and consent to participate
Written informed consent was obtained from the patient’s parents for publication of this paper and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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- Mehendale S, Kumar CP, Venkatasubramanian S, Prasanna T. Intussusception in Children Aged Less than Five years. Indian J Pediatr. 2016. [Epub ahead of print].Google Scholar
- Bk G, Hm Q, Pk C, Tan K, Tay K, Kw E, et al. Predictive factors of malignancy in adults with intussusception. World J Surg. 2006;30:1300–4.View ArticleGoogle Scholar
- Akbulut S. Unusual cause of adult intussusception: diffuse large B-cell non-Hodgkin’s lymphoma: a case report and review. Eur Rev Med Pharmacol Sci. 2012;16:1938–46.PubMedGoogle Scholar
- Ghimire P, Wu GY, Zhu L. Primary gastrointestinal lymphoma. World J Gastroenterol. 2011;17:697–707.View ArticlePubMedPubMed CentralGoogle Scholar
- Xu XQ, Hong T, Li BL, Liu W. Ileo-ileal intussusception caused by diffuse large B-cell lymphoma of the ileum. World J Gastroenterol. 2013;19:8449–52.View ArticlePubMedPubMed CentralGoogle Scholar
- Stein H, Warnke RA, Chan WC, Jaffe ES, Chan JKC, Gatter KC, Campo E, et al. Diffuse large B-cell lymphoma, not otherwise specified. In: Swerdlow SH, Campo E, Harris NL, editors. WHO classification of tumours of haematopoietic and lymphoid tissues. 4th ed. Lyon, France: IARC; 2008. p. 233–7.Google Scholar
- Simpson T, Ivey J, Borkowski S. Pediatric management problems. Intussusception Pediatr Nurs. 2004;30:326–7.PubMedGoogle Scholar
- Kim SJ, Kang HJ, Kim JS. Comparison of treatment strategies for patients with intestinal diffuse large B-cell lymphoma: surgical resection followed by chemotherapy versus chemotherapy alone. Blood. 2011;117:1958.View ArticlePubMedGoogle Scholar
- Inaba K, Kushima R, Murakami N, Kuroda Y, Harada K, Kitaguchi M, et al. Increased risk of gastric adenocarcinoma after treatment of primary gastric diffuse large B-cell lymphoma. BMC Cancer. 2013;13:499.View ArticlePubMedPubMed CentralGoogle Scholar