A case of multiple recurrent intussusceptions due to multiple lymphomatous polyposis associated with diffuse large B-cell lymphoma of gastrointestinal tract in a 15-year-old child: A rare case report

Sharma, Kapil Dev; Massey, Ashish V.; Vijayvargiya, Manish; Jain, Sundeep

INTRODUCTION AND IMPORTANCE: Multiple lymphomatous polyposis (MLP) is a distinctive and rare entity of primary gastrointestinal (GI) lymphoma characterized by polypoid lymphomatous tissue in long segments of the gut and a strong tendency for spread throughout the GI tract. Although many cases of MLP presenting as intussusceptions in adults have been reported, we report a rare case of multiple recurrent intussusceptions due to MLP associated with high-grade Diffuse Large B-cell lymphoma (DLBCL) of the entire GI tract in a 15-year-old child. CASE PRESENTATION: A 15-year-old child previously operated for acute intestinal obstruction, presented with intermittent abdominal pain, nausea and vomiting. Imaging studies confirmed the diagnosis of multiple small bowel intussusceptions. Patient was treated by exploratory laparotomy and multiple resection anastomosis. Histopathology confirmed the diagnosis of MLP due to DLBCL. The patient received chemotherapy following surgery. So far, at 6 months of follow-up, Patient is doing well. CLINICAL DISCUSSION: Malignant tumors of the small intestine are unusual, with non-specific clinical presentation. Although ultrasound (US), CT, FDG-PET/CT and endoscopic evaluation are essential modalities for the diagnosis of intestinal polyposis. Final diagnosis of MLP can only be confirmed after histopathological examination and immunohistochemistry studies. Surgical resection followed by appropriate chemotherapy is the treatment of choice. CONCLUSIONS: MLP due to DLBCL has rarely been described in young patients under the age of 18 years. We should keep a high index of suspicion for malignant GI lymphoma in cases of intussusception, especially in older children.