Rare presentation of B-lymphoblastic leukemia/lymphoma with intussusception in an adult

We present a case of a 46-year-old man with no pertinent medical or surgical history who presented with severe abdominal pain, nausea, and emesis. An abdominal CT scan was suggestive of strangulation of the distal small bowel and ischemia, showed extensive matted lymphadenopathy in the mesentery, and multiple left suprarenal periaortic nodes. A bowel resection was performed and there was an ileocolonic intussusception with the right colon filled with the intussuscepted terminal ileum. Opening the specimen revealed a submucosal ileal mass that measured 3  × 2.2 × 1.3 cm with a well-circumscribed, yellow-white cut surface. Histological examination showed a diffuse infiltrate composed of small- and medium-sized cells extending through the ileal wall from mucosa to subserosa, with irregular nuclear contours, open chromatin, inconspicuous nuc leoli, occasional mitoses, and frequent apoptotic bodies. Flow cytometric analysis revealed 29% B-lymphoblasts corresponding to the diagnosis of B-LBL.BCR/ABL translocation by FISH was not detected. Cytogenetics analysis showed a normal male karyotype 46,XY. B-LBL is a rare neoplasm in older adults and can involve nodal and extranodal sites; however, the gastrointestinal tract is rarely compromised, with only a few cases reported in the literature.
Source: Journal of Hematopathology - Category: Pathology Source Type: research