粘膜相关淋巴组织结外边缘区淋巴瘤(EMZL),也被称为MALT淋巴瘤,是一种结外多器官侵袭性增生性淋巴瘤,由形态可变的小B细胞组成。它最常见于消化道,胃部患病率很高,但起源于小肠的EMZL很少见,临床表现缺乏特异性,很容易被误诊.在这里,我们报告了一例罕见的小肠EMZL表现为肠套叠的病例,该病例为32岁男性.在当地医院进行的结肠镜检查发现一个大小约为5厘米×5厘米的带蒂息肉,表面粗糙,回盲区出现充血。他被送进我们医院做息肉切除手术。对比增强计算机断层扫描(CT)扫描提示回肠肠套叠,随后在我们医院的结肠镜检查证实了这一点。成人肠套叠相对罕见,90%的病例具有已知的致病机制,40%的病例由原发性或继发性恶性肿瘤引起。因此,我们对患者进行了腹腔镜辅助右半结肠切除术.切除的标本显示回肠末端肠套叠进入升结肠,肠套叠为充血和水肿。肠套叠结束时可见2.5cm×2.5cm×1.5cm肿块。术后病理显示肿块为EMZL,部分转化为大B细胞淋巴瘤。患者转入血液科,完成PET-CT显示原发性肠淋巴瘤的术后表现,卢加诺上演IE2。尽管EMZL是一种惰性淋巴瘤,患者处于早期阶段,利妥昔单抗,环磷酰胺,阿霉素,长春新碱,鉴于组织学转变,给予泼尼松(R-CHOP)方案。患者正在定期随访。这是一例罕见的由于EMZL引起的小肠肿块,在成人中表现为肠套叠,强调了腹腔镜辅助肠切除术是小肠EMZL多学科协作治疗的潜在治疗方法。
Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (EMZL), also known as MALT lymphoma, is an extranodal multiorgan-invasive proliferative lymphoma composed of small B cells with variable morphology. It most commonly occurs in the digestive tract, with a high prevalence in the stomach, but EMZL originating in the small intestine is rare and lacks specificity in clinical manifestations, which makes it easy to be misdiagnosed. Herein, we report a rare case of small intestinal EMZL presentation as intussusception in a 32-year-old man. A colonoscopy performed at the local hospital revealed a pedicled polyp about 5 cm × 5 cm in size with a rough surface, and hyperemia was seen in the ileocecal region. He was admitted to our hospital for a polypectomy. A contrast-enhanced computed tomographic (CT) scan suggested ileocolic intussusception, which was subsequently confirmed by a colonoscopy in our hospital. Adult intussusception is relatively rare, with 90% of cases having a known causative mechanism and 40% of cases caused by primary or secondary malignancies. Therefore, we performed a laparoscopic-assisted right hemicolectomy for the patient. The resected specimen showed that the terminal ileum was intussuscepted into the ascending colon, and the intussusception was hyperemia and edema. A 2.5 cm × 2.5 cm × 1.5 cm mass was seen at the end of the intussusception. Postoperative pathology revealed that the mass was EMZL, partially transformed into a large B-cell lymphoma. The patient was transferred to the hematology department and completed a PET-CT showing postoperative manifestations of primary intestinal lymphoma, Lugano staging IE2. Although EMZL was an indolent lymphoma and the patient was in the early stages, the rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) regimen was given in view of the histological transformation. The patient is in regular follow-up. This was a rare case of small intestinal mass due to EMZL presented as intussusception in adults, which highlighted laparoscopic-assisted enterectomy as a potential therapeutic approach in the multidisciplinary collaborative therapy of small intestine EMZL.