Presentation
History of C. difficile colitis and abdominal pain.
Patient Data
Mushroom-shaped soft tissue mass (on axial images) at the terminal ileum protruding into the caecal base, with some degree of intussusception. No obstruction.
Few borderline ileocolic lymph nodes. No other sites of disease.
Pathology report:
FINAL DIAGNOSIS:
Colon and terminal ileum, right, hemicolectomy:
- diffuse large B-cell lymphoma
- two lymph nodes positive for diffuse large B-cell lymphoma
Case Discussion
Primary lymphoma of the terminal ileum. The differential for a mass in this location is lymphoma, adenocarcinoma, GIST, and carcinoid tumour. Lymphoma can be slightly favoured due the bland, soft-tissue appearance of the mass and lack of adenopathy that would be expected in the setting of adenocarcinoma this size.
It is helpful to at least suggest lymphoma as this patient might be treated with systemic therapy (rather than hemicolectomy) in the absence of obstruction. This patient underwent right hemicolectomy due to symptoms related to intussusception.