Diffuse large B-cell lymphoma of ileum (pathology)

Case contributed by Andrew Ryan


Small bowel thickening on CT. Past history of AML with bone marrow transplant.

Patient Data

Age: 50 years
Gender: Female

The terminal ileum has been cut longitudinally at the site of ulceration to display the associated wall thickening with indurated pericolic fat.

Histological examination confirmed surface ulceration with destruction and replacement of the underlying submucosa and muscle wall by an undifferentiated tumor arranged in sheets. These are confirmed on immunohistochemistry to be lymphoid (B-cell) in nature.  

Low power of bowel wall with replacement by sheets of tumor cells.

High power of tumor cells showing large irregular nuclei, large nucleoli, and minimal cytoplasm. The cells show no evidence of differentiation, including no glandular differentiation (carcinoma) or melanin pigmentation (melanoma).

CD20 stain (B-cell marker) - There is positive staining indicating a B-cell lineage. The T-cell stains showed reactive background T-cells only.

Cytokeratin (epithelial marker) - negative.

S-100 (melanoma marker) - negative.

Case Discussion

Lymphoma of the small bowel is rare and more commonly mucosal based and of T-cell origin. This case shows involvement of the small bowel by a high grade, infiltrative and destructive lymphoma, with histological and immunohistochemical features in keeping with diffuse large B-cell lymphoma (DLBCL). 

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