P0939 - A Success Story: How Early Surgical Intervention Caused Complete Remission of Mantle Cell Lymphoma, with an Unusual Initial Presentation of Ileoileal Intussusception

Sindhusha Veeraballi, MD¹, Erinie Mekheal, MD², Vinesh Kumar, MBBS, MD³, Nader Mekheal, MD⁴, Vinod Kumar, MD⁵, Michael Maroules, MD^6
1Saint Michaels Medical Center, Newark, NJ; ²St. Joseph Medical Center, Paterson, NJ; ³Hackensack Meridian Ocean Medical Center, Karachi, Sindh, Pakistan; ⁴St. Joseph University Medical Center, Wayne, NJ; ⁵St. Joseph's Hospital and Medical Center, Paterson, NJ; ⁶St. Joseph's University Medical Center, Paterson, NJ

Introduction: Mantle cell lymphoma(MCL) is an aggressive form of B cell Non Hodgkin's lymphoma(NHL) which accounts for approximately 6% of all NHL cases in the United States. It arises from the malignant transformation of B lymphocytes in the mantle zone of the lymph node and is usually associated with the reciprocal translocation t(11;14) leading to overproduction of cyclin D1. Here in, we report a rare case of mantle cell lymphoma in a healthy male with ileoileal intussusception as initial presentation. Complete remission at 3 year follow up was maintained with timely surgical intervention and chemotherapy.

Case Description/Methods: A 55-year-old Peruvian male presented with nausea, non-bilious vomiting and left lower quadrant abdominal pain for 1 day. He denied having any B symptoms. Physical examination revealed mild tenderness in the left lower quadrant of the abdomen. Contrast-enhanced computed tomography (CE-CT) of abdomen and pelvis revealed distal small bowel intussusception measuring 5.5 cm in length with colonic wall thickening and an enlarged mesenteric lymph node measuring 2x2.1x1.6 cm. Diagnostic laparoscopy revealed ileoileal intussusception with mass and erythema surrounding mesenteric lymphadenopathy. 15 cm of distal ileum was resected and excisional biopsy of mesenteric lymph node was done. Histopathology confirmed the diagnosis of mantle cell lymphoma. Immunohistochemical staining was positive for CD20, CD5, BLC, BCL2 and CD43. Ki67 index was low (approx 10%). He was started on R-CHOP regimen (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine and Prednisone) and remains in complete remission at 3 year follow up.



Discussion: Intussusception in adults is very rare and accounts for only 5% of all intussusceptions. Malignant lymphomas account only for 1% of adult intussusception. Although the extranodal involvement of Non Hodgkins lymphoma is common in the gastrointestinal tract, mantle cell lymphoma initially presenting as ileoileal intussusception in a healthy adult is unusual. Very few cases of mantle cell lymphoma with intussusception were reported before. This case is a reminder for all physicians to keep malignant lymphomas in the differentials when treating adult intussusception. By reporting our case, we emphasize the possibility of hidden malignancies in adults with intussusception and the need for early surgical intervention. Our case is a proof to say that timely surgical intervention can improve the overall survival and quality of life in patients with mantle cell lymphoma.


Disclosures:
Sindhusha Veeraballi indicated no relevant financial relationships.
Erinie Mekheal indicated no relevant financial relationships.
Vinesh Kumar indicated no relevant financial relationships.
Nader Mekheal indicated no relevant financial relationships.
Vinod Kumar indicated no relevant financial relationships.
Michael Maroules indicated no relevant financial relationships.


Sindhusha Veeraballi, MD¹, Erinie Mekheal, MD², Vinesh Kumar, MBBS, MD³, Nader Mekheal, MD⁴, Vinod Kumar, MD⁵, Michael Maroules, MD⁶. P0939 - A Success Story: How Early Surgical Intervention Caused Complete Remission of Mantle Cell Lymphoma, with an Unusual Initial Presentation of Ileoileal Intussusception, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.