Recurrent small bowel obstruction caused by Burkitt lymphoma in an elderly man: a case report and review of the literature

Burkitt's lymphoma with multi-organ involvement

INTRODUCTION AND IMPORTANCE

Burkitt's lymphoma (BL) is an aggressive and rapidly growing B-cell non-Hodgkin lymphoma (NHL) with high rates of extranodal involvement. Primary gastrointestinal lymphomas represent a rare entity with less than 2 % of small intestinal malignancies.

CASE PRESENTATION

The patient was a 34-year-old man known case of sickle cell trait, presented with abdominal pain, anorexia, nausea, vomiting, constipation, and weight loss of 5 kg during three weeks. The vital signs were within normal ranges. His physical examination revealed abdominal tenderness on the right lower quadrant. Abdominal CT scan showed severe abdominopelvic ascites with ileocecal mass and nodular thickening of the parietal peritoneum. The patient underwent a cecum mass with peritoneal mass resection and appendectomy. In histopathology, Burkitt's lymphoma with peritoneal, omentum, and appendix involvement was diagnosed. For further evaluation, the patient underwent a bone marrow trephine biopsy that was involved. Finally, the patient was diagnosed with Burkitt's lymphoma with multi-organ involvement.

CLINICAL DISCUSSION

Patients with sporadic BL often present with advanced-stage disease due to the short doubling time of the tumor. In histopathology, the lymph node architecture effaces completely with starry sky appearance. The GI wall thickening and lumen Stenosis are common in cases with gastrointestinal Lymphoma.

CONCLUSION

We report a rare case of BL with multi-organs involvement such as cecum, appendix, peritoneum, omentum, and bone marrow. This case report highlights the importance of clinicopathologic correlation in the diagnosis of BL in daily practice.

Burkitt's lymphoma revealed by intestinal obstruction: A case report

Intestinal obstruction is a surgical emergency frequently encountered in routine practice, usually caused by abdominal adhesions. Although extra nodal lymphoma is most often localized in the gastrointestinal tract and may be responsible for intestinal obstruction, Burkitt's lymphoma is a very rare cause in adults. We report a case of Burkitt's lymphoma mimicking an intestinal obstruction in a 48-year-old adult who presented with an obstructive syndrome and altered general condition. Imaging and anatomopathological examination after immunohistochemical analysis concluded to a multi-systemic Burkitt's lymphoma. Chemotherapy was immediately started with complete remission.

Emergency laparotomy for abdominal catastrophes secondary to lymphoma: A systematic review

Intestinal lymphomas can rarely present as abdominal catastrophes with perforation or small bowel obstruction. There is little data regarding their optimal surgical management and associated outcomes. We aimed to systematically review relevant published literature to assess the presentation, diagnosis, optimal surgical approach and associated post-operative outcomes. A systematic on-line literature search of Embase and Medline identified 1485 articles of which 34 relevant studies were selected, including 7 retrospective studies, 1 case series and 26 case reports. Selected articles were assessed by two reviewers to extract data. 95 patients with abdominal catastrophes secondary to lymphoma (predominately Burkitt (28 %) and Diffuse Large B-cell lymphoma (29 %)) were identified with a median age of 52 years, 40 % were female. Of the small bowel resections 25% (n = 18) suffered post-operative complications with a 13.8 % (n = 10) 30-day mortality. Ileocolonic resections had a 27 % complication rate with 18 % mortality and primary repair had a 25 % complications rate and 25 % mortality. Median follow-up was 8 days (range 1-96). Notable points of differences in the presentations between these different lymphomas included the majority of Burkitt's lymphoma were younger, had a known diagnosis, were on chemotherapy and presented with perforation in contrast to those with B cell lymphoma who were predominately older, had new diagnoses and presented with a balanced proportion of obstruction and perforation. Abdominal catastrophes secondary to intestinal lymphomas most commonly present with perforation. Aggressive surgical management, including small bowel resection, may offer similar remission rates for lymphoma patients presenting with abdominal catastrophes as those without such emergency complications.

Intestinal occlusion due to Burkitt lymphoma: an unusual cause

We present the case of a 37-year-old Caucasian woman, with no history of interest, who came to the emergency room for an occlusive condition of 24 hours' evolution. The patient reported a weight loss of 12 kg in the last month, as well as the appearance of a lump in the left breast in the last week. A chest-abdominal CT scan revealed multiple solid-appearing nodules in the left breast, a metastatic liver lesion, and a tumor-like mass in the right iliac fossa measuring 90x60 mm. A biopsy of the breast lesion revealed a diffuse architectural pattern with destruction of the parenchyma and irregular medium-large cellularity with intense and diffuse expression of CD20, CD10 and Bcl6 and a proliferative index of practically 100%, consistent with lymphoma. Burkitt stage IV. Intestinal obstruction constitutes about 15% of hospital admissions for abdominal pain, representing a significant cause of hospital mortality. Although the most common causes of small bowel obstruction are benign (adhesions, hernias), intraluminal lesions such as inflammatory bowel disease or neoplasms are well-established causes associated with this clinical picture. Lymphomas constitute 25% of cases of intestinal obstruction of neoplastic origin; among them, Burkitt lymphoma is a rare type of B-cell lymphoma characterized by rapid and aggressive cell growth, the most common initial involvement of which is located at the abdominal and extra-nodal level.