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Hye Yoon Jang, Jong Yoon Lee, Suk Hyun Kim, Min Gyoung Pak1, Jong Hoon Lee
Abstract
Intussusception is a rare disease in adults. A demonstrable etiology is found in approximately 85% of all cases, and approximately 40% of them are caused by malignant tumors. A 65-year-old patient visited the outpatient department with mild abdominal pain without other symptoms. The initial laboratory test and simple X-ray showed normal findings. CT revealed intussusception in the ileocecal area. The initial colonoscopic biopsy revealed atypical cells. Follow up colonoscopy showed spontaneous reduction of the intussusception. Diffuse large B-cell lymphoma was suspected in the second colonoscopic biopsy. An elective operation was performed. This case reports a case of a spontaneous reduction of adult intussusception with a brief review of literature.
Figures and Tables
Fig. 1
(A) A mass like lesion with mild contrast enhancement (white arrow) is observed in the cecum. The proximal ileocecal valve shows a crescent shape. (B) Enlarged lymph node (white arrow) is observed adjacent to the ileocecal area.
Fig. 2
(A) The normal cecum and the intussuscepted ileocecal valve are observed like a mass. The upper part of the intussuscepted region (white arrow) was firm and showed mucosal erythema. At the lower part, a normal ileal mucosa is observed. (B) Other side view of the intussuscepted lesion. (C, D) Biopsies were done at the marked area (white arrows).
Fig. 3
(A) The normal cecum and the ileocecal valve are observed. (B–D) Two fungating masses were observed (B, C: proximal terminal ileum; D: distal terminal ileum).
Fig. 4
(A) Micrograph of the ileal mass. The submucosal layer is invaded by atypical cells (H&E, ×20). (B) The nuclei of atypical cells are three times larger than normal lymphocytes and scattered diffusely (H&E, ×200). (C) Tumor cells can be diagnosed as a diffuse large B-cell lymphoma when the findings of (B) demonstrate a strong positive for CD20 immunostaining, a B-cell marker (CD20 immunohistochemical, ×200). (D) Tumor cells are positive for CD10 and correspond to the germinal center B type according to the Hans classification (CD20 immunohistochemical, ×20).
References
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