Non-Hodgkin Lymphoma Initially Presenting as Acute Appendicitis: A Case Report
Keywords:
Non-Hodgkin’s lymphoma, Ascending colon, Acute appendicitisAbstract
Non-Hodgkin lymphoma (NHL) of the ascending colon is the rare tumor. Moreover, NHL with clinical presentation that mimics acute appendicitis, viz., the right lower quadrant (RLQ) abdominal pain with fever as in this report has been extremely rare. She was a 39-year old patient who was firstly diagnosed as having acute appendicitis because of having RLQ pain and tenderness for two days. Her blood showed Hb 12.5 g%, WBC 12,000/mm3, N 82%. The diagnosis of acute appendicitis was concluded hence the appendectomy was promptly performed. And its pathology was found to be caseating granulomatous lymphadenitis, no acid-fast bacilli or fungi documented. There was no fecalith, the common cause of acute appendicitis. However, she was continuously treated with standard anti-tuberculous regimen. Seven months later, she noticed the slowly growing intra-abdominal mass at the RLQ, without any constitutional symptom. The mass was around 10 x 10 cm in diameter without tenderness. The ultrasonography of the abdomen confirmed one lobulated mixed echoic mass at the RLQ, thickened wall of the ascending colon with diffuse liver metastasis. The right half colectomy was performed. The gross appearance of the mass was ulceroproliferative, 15 x 14 cm in diameter, and 4 cm in maximal thickness and it involved the entire circumference of the bowel wall. The pathology of the resected colon was diffuse large B cell lymphoma (DLBCL) involving the large and small bowels as well as pericolic tissue. Blood tests included: Hb 9.9 g%, WBC 6,100/mm3, alkaline phosphatase 176 U/L, HIV antigen / antibody-negative. She was finally diagnosed as having DLBCL of the ascending colon with the liver metastasis and further treated with the CHOP regimen without rituximab. She passed away due to febrile neutropenia within 3 weeks after the first course of chemotherapy.
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