Kusuma Victor Perdana, Vidyani Amie
Study Program of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
Gastroenterology and Hepatology Division, Department of Internal Medicine, Faculty of Medicine, Airlangga University - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
Int J Surg Case Rep. 2023 Dec;113:109046. doi: 10.1016/j.ijscr.2023.109046. Epub 2023 Nov 14.
Non-Hodgkin lymphoma of the duodenum with manifestation of hematemesis, melena, and obstructive jaundice is a rare occurrence.
A 47-year-old Indonesian man presented with symptoms of hematemesis of 3×/day, melena, abdominal pain, decreased appetite, and a weight loss (2 kg). The patient had symptoms of weakness, jaundice, pale conjunctiva, and experienced palpable discomfort in the epigastric region (VAS of 6). An abdominal ultrasonography revealed a heterogeneous cystic tumor mass measuring 45 × 29 mm located in the pancreas head. The gastrointestinal endoscopy revealed erosive gastritis and a tumor in the duodenum. The patient received a biliodigestive surgery and biopsy for double bypass. The pathological anatomy findings indicated the presence of non-Hodgkin lymphoma. The immunohistochemical results showed that the tumor cells were positive for CD45, CD20, and Ki67 95 % but negative for CK and CD3. The patient had a series of chemotherapy treatments include RCHOP, ICE, and EPOCH for a duration of 1½ years. Subsequently, the patient was assessed and pronounced to be cured.
The identification of diffuse large B-cell lymphoma (DLBCL) from duodenum in this case was challenging due to the presence of unspecific symptoms such as hematemesis, melena, and obstructive jaundice. Management of DLBCL involved surgical interventions and sequential chemotherapy, which have shown the most significant enhancement in prognosis.
The diagnostic accuracy of DLBCL from duodenal site enhances the effectiveness of the therapy employed, leading to a favorable prognosis.
十二指肠非霍奇金淋巴瘤伴呕血、黑便及梗阻性黄疸表现较为罕见。
一名47岁的印度尼西亚男子出现每日3次呕血、黑便、腹痛、食欲减退及体重减轻（2千克）的症状。患者有虚弱、黄疸、结膜苍白症状，上腹部可触及不适（视觉模拟评分6分）。腹部超声显示胰头有一个大小为45×29毫米的不均匀囊性肿瘤块。胃肠内镜检查发现糜烂性胃炎及十二指肠肿瘤。患者接受了胆肠吻合术及双旁路活检。病理解剖结果显示存在非霍奇金淋巴瘤。免疫组化结果显示肿瘤细胞CD45、CD20及Ki67 95%呈阳性，但细胞角蛋白和CD3呈阴性。患者接受了一系列化疗，包括RCHOP、ICE和EPOCH，持续1.5年。随后，对患者进行评估并宣布已治愈。
由于存在呕血、黑便及梗阻性黄疸等非特异性症状，在该病例中从十二指肠识别弥漫性大B细胞淋巴瘤（DLBCL）具有挑战性。DLBCL的治疗包括手术干预及序贯化疗，这已显示出对预后有最显著的改善。
十二指肠部位DLBCL的诊断准确性提高了所采用治疗的有效性，从而带来良好的预后。
