1574 An Unusual Finding of Non-Hodgkin's Lymphoma in the Gastrointestinal Tract

Abstract

INTRODUCTION: Primary gastrointestinal lymphomas include a small proportion of gastrointestinal cancers but rarely involve the ileocecal valve. Even though early detection and diagnosis is prudent in the care as it is associated with favorable therapeutic options, diagnosis with colonoscopy requires a high suspicion and precision. We report an unusual presentation of B-cell lymphoma at the ileocecal valve diagnosed on colonoscopy. CASE DESCRIPTION/METHODS: A 55-year-old female with no significant past medical history presented with a positive fecal occult blood test at her primary care office. Her brother was recently diagnosed with colon cancer at the age of 58. Physical examination was unremarkable and laboratory tests revealed mild iron-deficiency anemia with hemoglobin of 11 gm/dl. Colonoscopy revealed a tubular adenoma in the ascending colon. Colonoscopy is done after five years revealed a prominent ileocecal valve. Histopathological examination of the biopsy showed diffuse infiltration of mononuclear cells with large malignant cells along with pleomorphic vesicular nuclei and prominent nucleoli. A diagnosis of malignant follicular B type lymphoma was made and the patient is scheduled for treatment with an oncologist. DISCUSSION: Gastrointestinal non-Hodgkin's lymphomas are usually detected in the stomach and duodenum. As per our knowledge, this is the first case of B-cell lymphoma involving the ileocecal valve with no major derangement or deformity on the macroscopic exam. Clinicians must be wary of the clinical presentation and consider the possibility of a primary lymphoma at the ileocecal valve with minor changes in appearance, especially in patients with a family history of malignancy.