Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2020; 8(2): 306-312
Published online Jan 26, 2020. doi: 10.12998/wjcc.v8.i2.306
Recurrent lymphoma presenting as painless, chronic intussusception: A case report
Parker Giroux, Anderson Collier, Michael Nowicki
Parker Giroux, Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS 39216, United States
Anderson Collier, Division of Pediatric Hematology and Oncology, University of Mississippi Medical Center, Jackson, MS 39216, United States
Michael Nowicki, Division of Pediatric Gastroenterology, University of Mississippi Medical Center, Jackson, MS 39216, United States
Author contributions: Giroux P wrote the case report portion and edited the final manuscript; Collier A reviewed and edited the final manuscript; Nowicki M wrote the discussion portion and reviewed and edited the final manuscript.
Informed consent statement: Informed consent was given by the parents.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Michael Nowicki, MD, Professor, Director of Pediatric Endoscopy, Division of Pediatric Gastroenterology; University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, United States. mnowicki@umc.edu
Received: September 26, 2019
Peer-review started: September 26, 2019
First decision: October 24, 2019
Revised: December 17, 2019
Accepted: December 21, 2019
Article in press: December 21, 2019
Published online: January 26, 2020
Processing time: 112 Days and 8 Hours
Abstract
BACKGROUND

The clinical presentation of acute lymphoblastic lymphoma is highly varied. While prognosis is good, recurrence of disease can occur. Gastrointestinal relapse, including intussusception, is well-described but the absence of abdominal pain in this setting is rare.

CASE SUMMARY

We report a 13-year-old male with B-cell precursor acute lymphoblastic leukemia in remission presenting with anemia and weight loss. Examination was significant for absence of abdominal pain, but a stool sample was positive for occult blood. Pan-endoscopy was performed with colonoscopy revealing a mass filling the colonic lumen. Biopsy of the mass confirmed recurrence of recurrent B-cell lymphoma. Computed tomography scan revealed ileocolic intussusception resulting from the tumor. This case is unusual in that the patient had no abdominal pain despite the presence of intussusception.

CONCLUSION

While intestinal involvement with lymphoma has been well described in the literature, presentation as painless intussusception has not been reported. This case report highlights the wide spectrum of clinical manifestations of recurrent B-cell lymphoma involving the gastrointestinal tract, in particular the near absence of symptoms despite the finding of intussusception.

Keywords: B-cell acute lymphoblastic leukemia; Tumor relapse; Intussusception; Case report; Anemia

Core tip: Acute lymphoblastic leukemia and recurrent B-cell lymphoma are known to present in the gastrointestinal tract, most commonly with abdominal pain, either alone or in association with other symptoms, including rectal bleeding, vomiting, and/or abdominal distention. A common presentation is that of intussusception. We report a patient who was found to have recurrent B-cell lymphoma leading to intussusception during colonoscopy being performed for evaluation of anemia. There were no other clinical features, including abdominal pain, to suggest intussusception prior to colonoscopy. This case should serve as a cautionary tale that serious complications resulting from acute lymphoblastic leukemia may occur despite minimal clinical symptoms.