Internal Medicine, Trinity Health Livonia, Livonia, MI, USA.
Internal Medicine, Western Michigan University Homer Stryker M. D. School of Medicine, Kalamazoo, MI, USA.
J Med Case Rep. 2024 Nov 1;18(1):530. doi: 10.1186/s13256-024-04810-x.
Anaplastic large-cell lymphoma primarily involving the omentum is an extremely rare entity with variable clinical presentation. Owing to its rarity and nonspecific clinical manifestation, omental T-cell lymphoma is often diagnosed at a later stage, riddled with complications. While imaging modalities such as computed tomography scan can help a physician reach a diagnosis, cases that present with complications may require a multidisciplinary approach that combines surgical exploration along with consultation from Oncology.
We hereby report a rare case of a 66-year-old African American male patient who presented to the emergency department with complaints of acute gastrointestinal obstruction. A computed tomography scan of the abdomen and pelvis revealed evidence of an internal hernia and surgical exploration revealed a hemorrhagic and infarcted omentum. Biopsies along with immunophenotypic studies confirmed the diagnosis of anaplastic T-cell lymphoma of the omentum complicated by Massilia timonae infection.
The case highlights the significance of considering lymphoma, although rare, as a differential in a patient who presents with small bowel obstruction and the importance of investigating for malignancy for early diagnosis and treatment of primary omental lymphomas, before complications develop.
原发于网膜的间变大细胞淋巴瘤是一种极其罕见的疾病，临床表现多样。由于其罕见性和非特异性临床表现，网膜 T 细胞淋巴瘤常常在较晚阶段才被诊断出来，此时已经出现多种并发症。虽然计算机断层扫描等影像学手段有助于医生做出诊断，但出现并发症的病例可能需要多学科的方法，包括手术探查和肿瘤学咨询。
我们在此报告一例罕见病例，一名 66 岁的非裔美国男性患者因急性胃肠道梗阻就诊于急诊科。腹部和骨盆的计算机断层扫描显示存在内疝的证据，手术探查显示出血性和梗死性大网膜。活检和免疫表型研究证实了诊断为间变大细胞淋巴瘤，合并有 Massilia timonae 感染。
该病例强调了在出现小肠梗阻的患者中，尽管罕见，但仍应考虑淋巴瘤作为鉴别诊断的重要性，以及在并发症发生之前，为了早期诊断和治疗原发性网膜淋巴瘤，对恶性肿瘤进行调查的重要性。
