Primary Ileal Diffuse Large B-Cell Lymphoma with Acute Intestinal Obstruction: Case Report and Narrative Literature Review
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Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma, but primary ileal presentation is rare and may mimic abdominal emergencies. We report the case of a 40-year-old man with acute intestinal obstruction and no B symptoms. Abdominal CT revealed stenotic wall thickening at the jejunoileal transition and lymphadenopathy. Emergency laparotomy with segmental enterectomy was performed. Immunohistochemical analysis showed CD20+, Bcl-2+, PAX-5+, Ki-67 70% DLBCL, with CD3 expression in reactive T lymphocytes, and CD10-, Bcl-6-, and MUM-1-, classifying the tumor as the non-GCB subtype according to the Hans algorithm. Complete staging was limited by the emergency setting and the limited resources of the service. After six cycles of R-CHOP, the patient achieved complete metabolic remission (Deauville 2) on follow-up PET/CT, with no recurrence. This case highlights the diagnostic challenge of ileal DLBCL as a cause of acute obstructive abdomen and the effectiveness of emergency surgical resection followed by immunochemotherapy, even in aggressive non-GCB subtypes, while demonstrating the diagnostic limitations imposed by the emergency setting.
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