A Case of Small Bowel Diffuse Large B-cell Lymphoma Mimicking Crohn's Disease

Tae Hyoung Koo; Won Jong Choi; Seung Hee Han; Su Young Kim; Jong Hun Lee

doi:10.4166/kjg.2015.65.4.241

Journal List > Korean J Gastroenterol > v.65(4) > 1007361

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Koo, Choi, Han, Kim, and Lee: A Case of Small Bowel Diffuse Large B-cell Lymphoma Mimicking Crohn's Disease

Case Report

Korean J Gastroenterol 2015;65(4):241-245.

Published online: 4 October 2015

DOI: https://doi.org/10.4166/kjg.2015.65.4.241

A Case of Small Bowel Diffuse Large B-cell Lymphoma Mimicking Crohn's Disease

Tae Hyoung Koo, Won Jong Choi, Seung Hee Han, Su Young Kim, Jong Hun Lee

Department of Internal Medicine, Dong-A Universitiy College of Medicine, Busan, Korea

Correspondence to: Jong Hun Lee, Division of Gastroenterology, Department of Internal Medicine, Dong-A Universitiy College of Medicine, 32 Daesingongwon-ro, Seo-gu, Busan 602-714, Korea. Tel: +82-51-240-5625, Fax: +82-51-242-5852, E-mail: jh2002@dau.ac.kr

Received 11 June 201413 October 2014 Accepted 13 October 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 66-year-old male with dyspepsia and weight loss was referred to our hospital for evaluation. On laboratory examination, anti-saccharomyces cerevisiae (ASCA)-IgA was positive and iron deficiency anemia was present. PET/CT and abdominal CT scan images showed multiple small bowel segmental wall thickening and inflammation. Capsule endoscopy images showed multiple small bowel ulcerative lesions with exudates. Based on laboratory test results and imaging studies, the patient was diagnosed with Crohn's disease and treated with prednisolone and 5-aminosalicylic acid (5-ASA). However, the patient underwent second operation due to small bowel perforation within 2 month after initiation of treatment. Pathology report of the resected specimen was compatible to primary small bowel diffuse large B cell lymphoma and pertinent treatment was given to the patient after recovery. Herein, we describe a case of primary small bowel diffuse large B cell lymphoma that was mistaken for Crohn's disease.

Keywords: Crohn disease, Intestinal, Diffuse large B-cell lymphoma

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Fig. 1.

(A) Conventional CT scan images show wall thickening and mucosal hyperenhancement on multiple segments of jejunum (arrows). (B) PET/CT scan images show increased uptake on multiple segments of jejunum.

Fig. 2.

Capsule endoscopy images show multiple ulcers on jejunum.

Fig. 3.

Gross and microscopic findings. (A) The resected jejunum shows multiple ulcers with perforations. (B) Microscopically, ill-defined ulcerative mass is seen throughout the jejunal wall (H&E, ×16). (C) Immunohistochemistry stain (CD20, ×100). CD20 is expressed in the tumor cells. (D) Large atypical lymphoid cell infiltration with non-cohesive pattern is observed on high-power field magnification (H&E, ×200).

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