Plasmablastic lymphoma as a rare cause of subocclusive events: Case report and review of the literature

Abstract

Introduction. The most common causes of subocclusive disorders are the adhesion, Crohn's disease and small bowel neoplasms. Plasmablastic lymphoma (PBL) is an aggressive distinct subtype of diffuse large B-cell non-Hodgkin lymphoma initially reported in the oral cavity of the HIV infected individuals. Case report. We presented a male patient with PBL of the small intestine as a rare cause of intestinal subocclusion, without HIV infection and negative serology for hepatitis C, hepatitis B, and Epstein-Barr infection. A 73-year-old male was admitted to our Center due to the one-year history of abdominal pain, weigh loss, non-bloody diarrhea, night sweating and pruritus. The patient underwent the ileocolonoscopic examination with the accompanying biopsy specimens. The results, based on the histopathological and immunohistochemical pattern, confirmed a diagnosis of PBL. Following the chemo-therapy treatment, our patient underwent the resection of ileum. The postoperative histopathological report confirmed PBL as the final diagnosis. The patient was treated for the following 6 months with the chemotherapy according to the cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) protocol. Fatal outcome was due to acute myocardial infarct. Conclusion. PBL of the small intestine is a rare and unusual cause of subocclusive events. In our patient, an accurate histopathological verification of the detected changes in the ileum was of crucial importance for further treatment.Uvod. Najčešći uzroci subokluzivnih poremećaja u adheziji, Kronova bolest i neoplazme tankog creva. Plazmablastni limfom (PBL) je tip agresivnog difuznog krupnoćelijskog B nehočkinskog limfoma, koji je prvi put opisan u usnoj duplji kod HIV pozitivnih bolesnika. Prikaz bolesnika. U radu je prikazan bolesnik sa PBL tankog creva kao retkim uzrokom subokluzije, bez HIV infekcije i sa negativnom serologijom za hepatitis B, hepatitis C i infekciju Epštajn-Barovim virusom. Muškarac, star 73 godine, primljen je u naš Centar zbog jednogodišnje istorije bolova u trbuhu, gubitku telesne mase, dijareje (bez krvi), noćnog znojenja i svraba. Bolesniku je urađena kolonoskopija sa terminalnom ileoskopijom, pri kojoj je uzeta biopsija sluznice terminalnog ileuma. Rezultati patohistološkog i imunohistohemijskog ispitivanja su potvrdili dijagnozu PBL. Posle hemioterapije, bolesniku je urađena resekcija ileuma. Rezultat postoperativne patohistološke analize je potvrdio dijagnozu PBL. Bolesnik je lečen po protokolu CHOP (ciklofofamid, doksorubicin, vinkristin i prednizolon) tokom šest meseci. Fatalan ishod je nastupio zbog infarkta miokarda. Zaključak. Mada redak i neuobičajen, uzrok subokluzivnih tegoba može biti PBL ileuma. Kod našeg bolesnika krucijalni značaj za dalje lečenje je imala tačna patohistološka verifikacija promena aktiviranih u ileumu.