Case: A 64-year-old man with no relevant history of dizziness and cervicalgia of a month
and a half of evolution, in whom normocytic anemia (9.8 g/dL) and positive fecal occult
blood were detected, and endoscopic studies were requested on an outpatient basis.
However, the patient went to the emergency room before these tests were performed
due to frank rectorrhagia with syncopal episode associated with constitutional syndrome.
An abdominal CT scan was completed, showing an ileal thickening of 12.3 x 9.2 cm with
no signs of active bleeding and no other associated lesions. Colonoscopy revealed
a large mameloned and ulcerated mass, not stenosing, at terminal ileum (2-3 cm from
ileocecal valve). Pathologic anatomy was conclusive for primary diffuse large B-cell
lymphoma (DLBCL) in terminal ileum. Referral to hematology and chemotherapy was initiated
[1]
[2]
[3].
Discussion: DLBCL is the most common histologic subtype of non-Hodgkin's lymphoma (approximately
25%). Gastrointestinal tract lymphoma is usually secondary to extranodal disease,
while primary gastrointestinal tract lymphoma is relatively rare, accounting for 1-4%
of malignancies arising, with the small bowel being the predominant site. This case
is unique given the low incidence and clinical variety of this entity. When faced
with clinical manifestations of rectorrhagia, it is essential to make a broad differential
diagnosis, emphasizing the importance of always intubating the ileocecal valve to
complete the study.
