International journal of surgery case reports · 2012
Mesentery lymphoma in a patient with Crohn's disease: An extremely rare entity.
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Koronakis Nikolaos, Lagoudianakis Emmanouil, Keramidaris Dimitrios, Pappas Apostolos, Gemenetzis George, Seretis Charalampos, Chrysikos John, Manouras Andreas
Аннотация
INTRODUCTION: Lymphoma is a rare complication of long-standing Crohn's disease. We report a rare case of a diffuse, B-cell non-Hodgkin's lymphoma of the mesentery in a patient receiving treatment for Crohn's disease.
PRESENTATION OF CASE: A 52 year-old patient presented with abdominal pain, anorexia and postprandial fullness. Abdominal examination revealed a firm mass, extending from the epigastrium to the right iliac fossa. CT scan showed a large intra-abdominal mass with air-fluid levels within, and soft tissue density along its walls, surrounded by distended bowel loops. The patient was scheduled for surgery due to clinical assumption of an intra-abdominal abscess. At laparotomy an ill-defined, lobulated mass with cystic areas was noted rising from the mesentery. Frozen section biopsy of the cystic mass revealed a non-Hodgkin follicle center B-cell lymphoma of the mesentery.
DISCUSSION: To the best of our knowledge, this is an extremely rare case of lymphoma development in the mesentery, in a patient receiving treatment for Crohn's disease. Although the development of abdominal lymphomas can be justified as a possible consequence of the chronic immune-modulating therapy, their location can lead to diagnostic pitfalls.
CONCLUSION: Although mesentery has scarcely been presented as a potential site of occurrence of abdominal lymphomas in the process of treatment of inflammatory bowel diseases, this rare entity should be considered in the differential diagnosis of intra-abdominal lymphomas in patients with inflammatory bowel disease. In cases where imaging techniques do not provide definitive answers, surgical intervention can safely pose the accurate diagnosis.
PRESENTATION OF CASE: A 52 year-old patient presented with abdominal pain, anorexia and postprandial fullness. Abdominal examination revealed a firm mass, extending from the epigastrium to the right iliac fossa. CT scan showed a large intra-abdominal mass with air-fluid levels within, and soft tissue density along its walls, surrounded by distended bowel loops. The patient was scheduled for surgery due to clinical assumption of an intra-abdominal abscess. At laparotomy an ill-defined, lobulated mass with cystic areas was noted rising from the mesentery. Frozen section biopsy of the cystic mass revealed a non-Hodgkin follicle center B-cell lymphoma of the mesentery.
DISCUSSION: To the best of our knowledge, this is an extremely rare case of lymphoma development in the mesentery, in a patient receiving treatment for Crohn's disease. Although the development of abdominal lymphomas can be justified as a possible consequence of the chronic immune-modulating therapy, their location can lead to diagnostic pitfalls.
CONCLUSION: Although mesentery has scarcely been presented as a potential site of occurrence of abdominal lymphomas in the process of treatment of inflammatory bowel diseases, this rare entity should be considered in the differential diagnosis of intra-abdominal lymphomas in patients with inflammatory bowel disease. In cases where imaging techniques do not provide definitive answers, surgical intervention can safely pose the accurate diagnosis.