A Rare Case of Primary Lymphoma of the Caecum Presenting as Intussusception
A 35-year-old woman presented with a pain in the right iliac fossa of one month duration with a sudden increase in the severity of the pain. On examination, a tender mass was palpable in the right iliac fossa. Ultrasound and CT scan of the abdomen revealed a ileocolic intussusception with homogenous enhancing mass lesion approximately 5.6 × 5.3 × 3.5 cms seen at the lead point. The ileocecal junction, cecum and ascending colon pulled up by intussusceptum. Multiple mesenteric nodes were seen. The differential diagnosis offered were adenoma/lymphoma. A right hemicolectomy was done with an uneventful postoperative course.\nOn gross examination, a fleshy circumscribed polypoid mass was seen at the caecum measuring 5.5 × 4.5 × 3.5 cm, with the cut surface showing areas of hemorrhage [].\nMicroscopy of the lesion with adjacent intestinal mucosa revealed necrosis of the mucosa. The lamina propria was infiltrated by a monotonous population of lymphoid cells that showed destruction of the glands and were seen extending into the muscularis propria and the serosa. The cells were small with irregular nuclear membrane, having hyperchromatic nucleus and scant cytoplasm. The tumor cells were characteristically arranged around the epithelium (lymphoepithelial lesion) []. Seventeen lymph nodes isolated showed reactive hyperplasia. A histological diagnosis of MALT lymphoma was offered. Immunohistochemistry was done which showed strong positivity of the tumor cells for CD-20 [] and negative for CD 10, thus confirming the diagnosis. The patient was referred to oncology for chemotherapy.