Burkitt's Lymphoma Causing Intussusception in Adults: Report of two Cases and Review of the Literature

Abstract

Background: Burkitt’s lymphoma (BL) related intussusception causing intestinal obstruction in adults is very rare. Two cases of BL related ileocecal intussusception were operated in our clinic and treatment options were explained with previous literature. Patients and Method: The English medical literature in the PubMed and Google Scholar databases was reviewed for adult related ileocecal intussusception, and 10 reports concerning 10 cases of intussusception due to BL were noticed. Our presented two cases of BL related ileocecal intussusception were 17 and 19 years old and both male. both operated due to acute abdomen. Results: The patients printed in the literature were aged from 16 to 52 years. According to the localization of lymphoma, 6 patients had ileo-colic intussusception, 2 had ileal, and 2 had colic intussusception. In terms of the diagnosis, 10 patients were diagnosed with computerized tomography (CT). Our patient one was 17 years old male complaining from abdominal pain, distention and not passing gas and flatus, having rebound and tenderness on the abdomen. Bowel sounds were increased and abdomen was distended. Laboratory values were normal. Patient was HIV negative and EBV was negative. CT showed" target”-shaped soft-tissue mass with a layering effect of ileo-colic intussusception. At exploration ileum was invaginated through ileocecal valve to cecum. Cecum mass about 5 cm in diameter was noticed. Right hemicolectomy and ileocolic anastomosis was performed. Macroscopy showed 6×5.5 cm polypoid tumor formation blocked the lumen. A few lymph node with the largest 2.5×2 cm were dissected in the mucosa. On immunohistochemical studies; CD20 in CD10 staining were observed strong positive staining. TdT, CD23, CD5 and bcl-2 staining were not observed. Ki-67 proliferation index was evaluated as 100%. Tumor involvement was observed diagnosis was BL. Our other patient 19 years male patients with abdominal pain and constipation. There was no history of weight loss or fever. Physical examination showed defans and rebound in the right lower quadrant of abdomen in both patients. Bowel sounds were increased. No evidence of any lymph nodes during systematic examination appeared. Laboratory values were normal with negative HIV. In situ hybridization for EB virus was negative forms of sporadic BL. Intravenous contrast for abdominal tomography was taken and A “sausage”-shaped soft tissue mass with ileo-colic intussusception appeared. 4 cm mass in the terminal ileum was palpated. patient had ileal resection and ileoileal anastomosis. Pathology showed a tumor 4 cm in diameter blocked ileum completely and infiltrated serosa of ileum. immunohistochemical studies CD20, CD10 staining were positive, CD3, CD5, CD23, bcl-6 and TdT staining were negative. Ki-67 proliferation index was 100%. Burkitt's lymphoma was diagnosed in the location of terminal ileum. Both patients was discharged with good bowel movements without any complication and referred to the hematology for chemotherapy treatment. Complete resection is very important and improve survival. Conclusion: BL related intussusception is very rare in adults. Complete resection is required and improve patient survival.