Primary Appendiceal Lymphoma Presenting as Perforated Appendicitis: A Case Report
DOI:
https://doi.org/10.21276/apalm.3388Keywords:
Primary appendiceal lymphoma, perforation, appendix, diffuse large B-cell lymphomaAbstract
Primary appendiceal lymphoma is very rare, representing about 0.015% of gastrointestinal lymphomas. It is difficult to diagnose clinically, as most cases present with symptoms resembling acute appendicitis.
Here, we present a case of appendiceal lymphoma that presented with acute perforation, diagnosed through imaging as free air foci in the abdominal cavity. The patient was operated on, and the tissue was sent for histopathology, where a diagnosis of primary appendiceal lymphoma was made. A Fluoro-deoxyglucose Positron Emission Tomography (FDG-PET) scan was performed post-operatively, which showed extensive involvement of the abdominal cavity.
Management is similar to that of primary gastrointestinal lymphoma, using a multimodal approach that includes surgery, chemotherapy, and radiotherapy. Due to her poor general condition, the patient could not tolerate the usual R-CHOP treatment, which includes cyclophosphamide, doxorubicin HCl, vincristine, and rituximab. Hence, she was started on mini-CHOP, which entails a reduced dosage of doxorubicin.
References
1. Caristo G, Griseri G, Fornaro R, Langone A, Franceschi A, Errigo V, et al. Primary lymphoma of appendix presenting as acute appendicitis: A case report. Int J Surg Case Rep. 2018;48:30-3.
2. Guo J, Wu G, Chen X, Li X. Primary appendiceal lymphoma presenting as suspected perforated acute appendicitis: clinical, sonography and CT findings with pathologic correlation. Int J Clin Exp Pathol. 2014;7(10):7068-71.
3. Liu KY, Wu SM, Chen WY, Chang CL. Primary appendiceal diffuse large B-cell lymphoma initially presenting as acute appendicitis: A case report. Int J Surg Case Rep. 2022;93:106933.
4. Radha S, Afroz T, Satyanarayana G. Primary marginal zone B-cell lymphoma of appendix. Indian J Pathol Microbiol. 2008;51(3):392-4.
5. Pickhardt PJ, Levy AD, Rohrmann CA Jr, Abbondanzo SL, Kende AI. Non-Hodgkin's lymphoma of the appendix: clinical and CT findings with pathologic correlation. AJR Am J Roentgenol. 2002;178(5):1123-7.
6. Ayub A, Santana-RodrÃguez N, Raad W, Bhora FY. Primary appendiceal lymphoma: clinical characteristics and outcomes of 116 patients. J Surg Res. 2017;207:174-80.
7. Taha-Mehlitz S, Bockmeyer J, Memeti E, Nowack M, Metzger J, Gass JM. Mantle cell lymphoma-rare differential diagnosis of a tumor in the vermiform appendix. J Surg Case Rep. 2019;2019(1)
8. El Bakouri A, Ballati A, Bouali M, Elhattabi K, Bensardi F, Fadil A. Primary appendiceal Burkitt's lymphoma presenting as acute appendicitis: An extremely rare case report and review of the literature. Ann Med Surg (Lond). 2020;61:16-8.
9. Suresh B, Asati V, Lakshmaiah KC, Babu G, Lokanatha D, Jacob LA, et al. Primary gastrointestinal diffuse large B-cell lymphoma: A prospective study from South India. South Asian J Cancer. 2019;8(1):57-9.
10. Fernandez Turizo MJ, Kharfan-Dabaja MA, Alhaj Moustafa M, Ayala E, Jiang L, Parrondo R. Primary diffuse large B-cell lymphoma presenting as acute appendicitis: A report of 2 cases and a literature review. Clin Case Rep. 2020;8(2):293-8.
11. Shannon EM, MacQueen IT, Miller JM, Maggard-Gibbons M. Management of Primary Gastrointestinal Non-Hodgkin Lymphomas: a Population-Based Survival Analysis. J Gastrointest Surg. 2016;20(6):1141-9.
12. D'souza MM, Jaimini A, Bansal A, Tripathi M, Sharma R, Mondal A, et al. FDG-PET/CT in lymphoma. Indian J Radiol Imaging. 2013;23(4):354-65.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Bipasha Sinha, Arpita Sutradhar, Sandip Kumar Bhattacharya, Vivek Goel, Anupam Chakrapani
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access at http://opcit.eprints.org/oacitation-biblio.html).