Swollen 2

A 27 year old man presents with right lower abdominal pain and intermittent passage of stools mixed with altered blood for 2 months.

The abdominal pain was colicky in nature and lasted for a variable duration each time, with spontaneous resolution. His bowel habits were unaltered.

He had also lost 3 kg of weight during the same time period, but was not anoretic.

His surgical history is unremarkable, while his medical history is significant for an episode of glandular fever 2 years ago. His family history is only significant for endometrial cancer in his mother which was diagnosed when she was 40 years of age.

He is not on any medications. He only drinks socially and denies smoking. A full blood count is performed, and found to be within normal parameters.

Select Relevant Investigations
Colonoscopy

Performed

There is a large, friable ileo-cecal mass measuring 4×4 cm; biopsies reveal a diffuse lymphoid infiltrate in the lamina propria, showing intermediate size cells that are mildly pleomorphic with prominent central basophilic nucleoli, cytoplasmic vacuoles and brisk mitotic activity.

Immunohistochemically, the lymphoid infiltrate was positive for CD45, CD20, CD10, and Bcl-6, consistent with a high grade non-Hodgkin B-cell lymphoma. The cells were negative for CD3, CD 5, Bcl-2 and TdT. The KI-67 proliferation index was positive in all tumor cells.

Cytogenetic studies of the lymphoid infiltrate revealed translocation(8;14) involving c-myc/IgH genes on respective chromosomes.
CT Abdomen

Performed

There is a 4.2 × 4.1 cm cecal mass with small adjacent lymph nodes, the largest measuring 1.4 × 0.6 cm. No other abnormalities are noted.
Bone Marrow Biopsy

Performed

The bone marrow biopsy appears completely normal.
CSF Analysis

Performed

The cerebrospinal fluid analysis is completely normal.

Select Relevant Management
IV Chemotherapy
Blood Transfusion
Monoclonal Antibody Therapy
Intrathecal Chemotherapy