Takayama Yuji, Saito Masaaki, Ichida Kosuke, Muto Yuta, Tanaka Akira, Rikiyama Toshiki
Department of Surgery, Jichi Medical University Saitama Medical Center, 1-chome-847 Amanuma-cho, Omiya-ku, Saitama City, Saitama, 330-8503, Japan.
Department of Pathology, Jichi Medical University Saitama Medical Center, 1-chome-847 Amanuma-cho, Omiya-ku, Saitama City, Saitama, 330-8503, Japan.
Int J Surg Case Rep. 2021 Feb;79:417-420. doi: 10.1016/j.ijscr.2021.01.085. Epub 2021 Jan 25.
Small intestinal perforation in patients with Burkitt lymphoma is extremely rare. We present the first report of such a case.
A 53-year-old woman was admitted with abdominal pain and vomiting. Abdominal examination revealed rigidity and tenderness in the upper abdomen. Computed tomography scan showed thickening of the wall of the jejunum, intra-abdominal free gas, and ascites; the patient was diagnosed with small intestinal perforation, and underwent emergency surgery on the same day. Laparoscopic findings were a 50 mm jejunal perforation and perforation in the transverse mesocolon. A partial jejunal resection of the perforated area, partial transverse colectomy, temporary colostomy, and intra-abdominal drainage were performed. Histological examination showed diffuse infiltration of medium-sized atypical lymphocytes in the perforated area, exhibiting a "starry sky" appearance. Immunostaining results showed that the atypical lymphocytes were CD20 and virtually 100% Ki-67 positive, and CD56, CD30, and EBER negative. The lesion was identified as Burkitt lymphoma (BL). The postoperative course was favorable. On postoperative day 18 the patient began chemotherapy through the hematology department. Currently, the patient is in remission.
The majority of the malignant lymphomas occurring in the digestive tract are identified in the stomach; over 90% are B-cell lymphomas and mucosa-associated lymphoid tissue lymphoma Nakamura et al. BL originating from the small intestine accounts for only about 9%.
The incidence of BL in the small intestine is low. Pretreatment BL can lead to bowel perforation. Prompt involvement of the hemato-oncologist after definitive diagnosis, and commencing chemotherapy as early as possible after surgery, are thought to improve prognosis.
伯基特淋巴瘤患者发生小肠穿孔极为罕见。我们报告首例此类病例。
一名53岁女性因腹痛和呕吐入院。腹部检查发现上腹部僵硬和压痛。计算机断层扫描显示空肠壁增厚、腹腔内游离气体和腹水；患者被诊断为小肠穿孔，并于同日接受急诊手术。腹腔镜检查发现一处50毫米的空肠穿孔和横结肠系膜穿孔。对穿孔区域进行了部分空肠切除、部分横结肠切除、临时结肠造口术和腹腔引流。组织学检查显示穿孔区域有中等大小非典型淋巴细胞弥漫浸润，呈现“星空”样外观。免疫染色结果显示非典型淋巴细胞CD20阳性且几乎100% Ki-67阳性，CD56、CD30和EBER阴性。病变被确诊为伯基特淋巴瘤（BL）。术后病程顺利。术后第18天患者开始通过血液科进行化疗。目前，患者处于缓解期。
发生在消化道的大多数恶性淋巴瘤位于胃；超过90%为B细胞淋巴瘤和黏膜相关淋巴组织淋巴瘤（中村等人）。起源于小肠的BL仅占约9%。
小肠BL的发病率较低。治疗前的BL可导致肠穿孔。确诊后血液肿瘤学家及时介入，并在术后尽早开始化疗，被认为可改善预后。
