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 22 October 2017

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GastroenterologySmall intestine

Malignant diseases

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Non-Hodgkin's large cell lymphoma of the small bowel.
A 70-year-old man was admitted with subacute small bowel obstruction. He was otherwise in good health. Initially thought to be due to adhesions. He had a past history of an open cholecystectomy and an appendicectomy. His symptoms did not settle, and the patient underwent laparotomy 3 days after admission. Dense adhesions were found at operation, but the cause of the obstruction was a small dense mass in the region of the ileocecal valve. A right hemicolectomy was performed. The opened specimen revealed an ulcerating neoplasm in the terminal ileum. The surrounding small bowel showed a large number of sessile polyps.

This photograph shows the malignant ulcer crater (in the centre of the picture), numerous sessile polyps in the small bowel, and the opened fold of the ileocecal valve to the left. Histologically the tumor proved to be an ulcerating diffuse non-Hodgkin's large cell lymphoma. The small polyps were islands of lymphoid hyperplasia.

Comment: Primary tumors of the small bowel are rare, and, of these, lymphomas form less than 20%. When primary lymphoma occurs, the ileum is the typical site. Risk factors include Crohn's disease, celiac disease, and AIDS. Typical presentations include perforation, obstruction, and hemorrhage. Curative resection for localized disease is associated with 5-year survival rates of over 70% (Eur J Surg Oncol 1999 Apr;25(2):164-7).

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Peter Devitt, Adelaide, Australia

Non-Hodgkin's large cell lymphoma of the small bowel.

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