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Malignant Lymphoma Involving Distal Ileum with Melena, Report of a Case T. Nishida 1 , S. Fuyuno 1 , T Fuchigami 1 , T. Yao 1 , T. Omae 1 , M. Furuyama 2 , H. Watanabe 3 , Y. Numaguchi 4 1The 2nd Dept. of Internal Medicine, Faculty of Medicine, Kyushu University 2The 2nd Dept. of Surgery, Faculty of Medicine, Kyushu University 3The 2nd Dept. of Pathology, Faculty of Medicine, Kyushu University 4Dept. of Radiology, Faculty of Medicine, Kyushu University pp.779-784
Published Date 1980/7/25
DOI https://doi.org/10.11477/mf.1403112673
  • Abstract
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 A 24 year-old man was admitted to our clinic because of melena. On admission, both an upper gastointestinal series and a barium enema were negative.

 Barium-filled picture of small intestine, however, disclosed abnormalities in the distal portion of the ileum, 6 cm in length and 40 cm oral from the terminal ileum, in which the margin was rigid and Kerkling's folds were abolished. The compression study revealed scant accumulation of the barium surrounded by irregular defects of the shadow, suggesting ulceration in tumor formation. The surface of the tumor appeared slightly uneven, and the displacement of the adjacent loops of small intestine demonstrated on the double contrast film, was indicative of an encircled extraluminal growing of this tumor.

 These roentgenological findings strongly suggested malignant lymphoma in the distal ileum. In addition, the superior mesenteric arteriography disclosing smooth encasement of branches of ileal artery by the tumor and faint neovascularies might indicate involvement of this disease in the ileum and also the mesenterium.

 On the 30th day of hospitalization, laparotomy was performed and large masses were found in the mesenteric lymph nodes and paraaortic regions besides the tumor of the distal ileum. The tumor was resected and the biopsy of the mesenteric lymph nodes was made.

 The resected tumor appeared grossly elastic, 7×4.5 cm in size, and creamy-gray in color. Irregular ulceration was seen on the surface of the tumor. The histological study revealed that the tumor was composed of abundant cellular components. Tumor cells, noted in the submucosal to the muscular layer and infiltrated to the serosa, were large in size having reticular or round to oval nuclei and clear nucleoli. The histological diagnosis was diffuse histiocytic lymphoma.

 In this case, the tumor of the distal ileum was thought to be metastic in origin of systemic malignant lymphoma rather than primary localized lymphoma in the ileum.


Copyright © 1980, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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