Obstructing Duodenal Diffuse Large B-cell Lymphoma with Peritoneal Lymphomatosis with Exceptional Response to R-CHOP

Abstract

Primary small bowel tumors are uncommon and usually carry a poor prognosis. Adenocarcinoma is the predominant histological type while lymphoma is far less common. Small bowel diffuse large B-cell lymphoma (DLBCL) can mimic adenocarcinoma; thus, the distinction can be challenging before tissue examination is performed. Bowel obstruction, as well as peritoneal involvement, are often seen in gastrointestinal (GI) adenocarcinoma cases; however, these features are extremely uncommon with GI lymphomas. Herein, the authors report an unusual case of an obstructing duodenal mass with peritoneal involvement, which was highly suspicious for an advanced duodenal adenocarcinoma. Surprisingly, sampling of the tumor revealed a diffuse large B-cell lymphoma.

Diffuse Large B-cell Lymphoma Presenting as Peritoneal Lymphomatosis: A Case Report and Literature Review

“…PL can be seen in many subtypes of non-Hodgkin lymphoma, which seems to converge with DLBCL in most cases (6). Cases of DLBCL with PL presentation that have been recently reported in the literature with a detailed description of clinical course are summarized in Table (8)(9)(10)(11)(12)(13)(14). The patients were middle-aged and older, with no marked difference in proportions between the sexes.…”

A rare case of Small Intestinal (Duodenal) diffuse large B-cell lymphoma (DLBL) in an elderly patient presented with gastrointestinal bleeding

“…The most commonly used chemotherapy regimen is R-CHOP, which is a combination of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone. [9,10,14] In patients with unfavorable prognostic factors, DA-EPOCH-R (dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab) may also be a beneficial treatment option [10,15]. Response to treatment is measured using data collected from the post-treatment history, physical, and imaging (PET/CT) scan results.…”

Complicaciones quirúrgicas del linfoma con compromiso gastrointestinal

“…Para el estudio de la obstrucción intestinal, la tomografía computarizada de abdomen con contraste intravenoso tiene una sensibilidad de 94 a 100 % y una especificidad de 90 a 95 % 18,26 . Es posible encontrar engrosamiento de la pared, lesiones infiltrativas o polipoides, dilatación aneurismática y conglomerados de ganglios linfáticos que disminuyen la luz intestinal 27 .…”