دانلود رایگان مقاله شیمی درمانی درهم رفتگی بزرگسال در لنفوم سلول B

abstract

Secondary adult intussusception is associated with a pathological condition involving a lead point, including malignant tumors such as a primary or metastatic adenocarcinoma, GIST, leukemia, lymphoma, or carcinoid tumor. Thirty percent of small intestine intussusception was caused by malignancy. Most of these malignancies were metastases, while primary small intestinal malignancy were rare. Intussusception in lymphoma patients has been reported, with predominant location of intussusception in the ileo-colica region. Intussusception occuring after chemotherapy has been reported in four cancer patient following chemotherapy, but no report about this condition in lymphoma patient. A 44-year-old female patient with DLBCL was diagnosed of intussusception eight days after the initiation of chemotherapy. Plain abdominal radiology and CT scan confirmed intussusception on the ileo-colica region. No surgical intervention was done due to the condition of the patient. This is the first reported case of inssusception in a DLBCL patient that had undergone chemotherapy for the lymphoma.

2. Discussion

Intussusception is the telescoping of a proximal segment of the gastrointestinal tract within the lumen of the adjacent segment [1]. Adult intussusception is not common [2]. Adult intussusception can be classified as primary or idiopathic and secondary. Primary intussusception accounts for 8–20% cases and is more likely to occur in the small intestine, while secondary intussusception is associated with a pathological condition involving a lead point. The pathological condition includes a benign polyp, lipoma, appendix, Meckel's diverticulum, or a malignant tumor such as a primary or metastatic adenocarcinoma, gastro intestinal stromal tumor (GIST), leukemia, lymphoma, or carcinoid tumor [1,3,4]. A study found that location of adult intussusception is the small intestine that accounts for 50–88% cases and the large intestine that accounts for 12–50% cases. Malignant lesions as the pathological condition was found in 30% of cases that occur small intestine, and in 30–68% of cases that occur in large intestine. Malignant lesions as cause of large intestine intussusception are colon adecocarcinoma, lymphoma, lymphosarcoma, and leiomyosarcoma. Malignant lesions as cause of small intestine intussusception are predominantly metastases. Primary small intestinal malignancy such as adenocarcinoma, carcinoid, GIST, or lymphoma rarely cause this condition [5]. The diagnosis of the patient in this case report was DLBCL, a varian of non-Hodgkin's lymphoma (NHL). She had no abdominal pathology found on history, physical or ultrasound examination at the time of diagnosis of lymphoma. She had nausea, vomit, and abdominal pain a week prior to admission, at the same time she had undergone chemotherapy. Thus the complaints were thought to be side effects of her chemotherapy. On the second day the patient's abdomen was distended with tenderness on palpation and absence of bowel movement. Her plain abdominal radiology and CT scan confirmed an intussusception on the ileo-colica region.