B-cell malt lymphoma of the small intestine

Abstract

A 67-year-old male patient was admitted to the gastroenterology department with complaints of rectal bleeding for 5-6 months and weight loss in suspicion of inflamatory bowel disease. Anemia, increasing rates of lymphocytes (16.2%) and monocytes (30.7%) were revealed in routine heamotological tests. During enteroscopy examination a nodular mucosal pattern and ulcerations with exudate in jejunum were also detected. The barium follow through examination of small intestine showed aneurysmal expansion, loss of peristaltic activity, mucosal oedema in nearly 20-25 cm of jejunum. In the absence of significant stenosis, aneurysmal expansion of the jejunum was suspicious for lymphomatous involvement of the intestine. Long segment concentric wall thickening of the jejunum, presence of mesenteric lymph nodes and after intravenous gadolinium administration a significant contrast enhancement of entire wall of involved jejunum were also seen on MR enterography examination. For the unprevented rectal bleeding the patient underwent a surgical procedure and during the operation a concentric wall thickening up to about 2 cm. of distal jejunum was encountered, the segmental resection of involved intestine and adjacent mesenteric lymph nodes were made. Jejunal and also nodal B cell malt lymphomatous involvement was histopathologically proven.