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Perforation in an intestinal malignant lymphoma case

BACKGROUND: The gastrointestinal tract is a relatively common involvement site in lymphoma and, in such cases, intestinal perforation is a concern before and during chemotherapy. The prediction of intestinal perforation prior to chemotherapy is difficult, and there is no standard strategy to minimiz...

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Autores principales: Imataki, Osamu, Shiroshita, Kohei, Uchida, Shumpei, Kida, Jun-ichiro, Akamoto, Shintaro, Uemura, Makiko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4906586/
https://www.ncbi.nlm.nih.gov/pubmed/27297406
http://dx.doi.org/10.1186/s13104-016-2111-6
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author Imataki, Osamu
Shiroshita, Kohei
Uchida, Shumpei
Kida, Jun-ichiro
Akamoto, Shintaro
Uemura, Makiko
author_facet Imataki, Osamu
Shiroshita, Kohei
Uchida, Shumpei
Kida, Jun-ichiro
Akamoto, Shintaro
Uemura, Makiko
author_sort Imataki, Osamu
collection PubMed
description BACKGROUND: The gastrointestinal tract is a relatively common involvement site in lymphoma and, in such cases, intestinal perforation is a concern before and during chemotherapy. The prediction of intestinal perforation prior to chemotherapy is difficult, and there is no standard strategy to minimize the frequency of severely adverse gastrointestinal events in lymphoma cases. CASE PRESENTATION: The 61-year-old female patient had a history of primary central nervous system lymphoma (PCNSL), diagnosed histologically as diffuse large B cell lymphoma (DLBCL). We administered six courses of intensive chemotherapy consisting of high-dose methotrexate and sequential whole-brain irradiation (40.5 Gy). After a 3-year remission of the PCNSL, the patient’s lymphoma recurred, involving the small intestine. (18)F-FDG-PET/CT upon the recurrence before chemotherapy showed multiple nodular lesions in the patient’s gastrointestinal tract. Central nervous system lesions were not detected. We administered intensive salvage chemotherapy consisting of cyclophosphamide, high-dose AraC, methyl-prednisolone, etoposide, and rituximab. The response was a rapid partial response, but on day 10 after the initiation of salvage chemotherapy, she complained of abdominal pain with tenderness. The contrast-enhanced (CE)-CT revealed transmural ischemia of the intestine. On the 7th day after the onset of urgent abdominal symptoms, follow-up CE-CT showed that the ischemic lesion had become thin. We conducted elective surgery after waiting for the complete recovery of the patient’s white blood cell count. The pathological findings of resected intestine confirmed the elimination of the majority of lymphoma cells and concomitant partial necrotic tissue. CONCLUSIONS: We were able to avoid the neutropenic period and safely conducted the surgical treatment for the subclinical perforation by using CE-CT. The combination of (18)F-FDG-PET/CT before chemotherapy and CE-CT scanning for the targeted involvement site helped us evaluate the surgical indications and optimal timing of surgery in a lymphoma patient with gastrointestinal involvement.
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spelling pubmed-49065862016-06-15 Perforation in an intestinal malignant lymphoma case Imataki, Osamu Shiroshita, Kohei Uchida, Shumpei Kida, Jun-ichiro Akamoto, Shintaro Uemura, Makiko BMC Res Notes Case Report BACKGROUND: The gastrointestinal tract is a relatively common involvement site in lymphoma and, in such cases, intestinal perforation is a concern before and during chemotherapy. The prediction of intestinal perforation prior to chemotherapy is difficult, and there is no standard strategy to minimize the frequency of severely adverse gastrointestinal events in lymphoma cases. CASE PRESENTATION: The 61-year-old female patient had a history of primary central nervous system lymphoma (PCNSL), diagnosed histologically as diffuse large B cell lymphoma (DLBCL). We administered six courses of intensive chemotherapy consisting of high-dose methotrexate and sequential whole-brain irradiation (40.5 Gy). After a 3-year remission of the PCNSL, the patient’s lymphoma recurred, involving the small intestine. (18)F-FDG-PET/CT upon the recurrence before chemotherapy showed multiple nodular lesions in the patient’s gastrointestinal tract. Central nervous system lesions were not detected. We administered intensive salvage chemotherapy consisting of cyclophosphamide, high-dose AraC, methyl-prednisolone, etoposide, and rituximab. The response was a rapid partial response, but on day 10 after the initiation of salvage chemotherapy, she complained of abdominal pain with tenderness. The contrast-enhanced (CE)-CT revealed transmural ischemia of the intestine. On the 7th day after the onset of urgent abdominal symptoms, follow-up CE-CT showed that the ischemic lesion had become thin. We conducted elective surgery after waiting for the complete recovery of the patient’s white blood cell count. The pathological findings of resected intestine confirmed the elimination of the majority of lymphoma cells and concomitant partial necrotic tissue. CONCLUSIONS: We were able to avoid the neutropenic period and safely conducted the surgical treatment for the subclinical perforation by using CE-CT. The combination of (18)F-FDG-PET/CT before chemotherapy and CE-CT scanning for the targeted involvement site helped us evaluate the surgical indications and optimal timing of surgery in a lymphoma patient with gastrointestinal involvement. BioMed Central 2016-06-13 /pmc/articles/PMC4906586/ /pubmed/27297406 http://dx.doi.org/10.1186/s13104-016-2111-6 Text en © The Author(s) 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Imataki, Osamu
Shiroshita, Kohei
Uchida, Shumpei
Kida, Jun-ichiro
Akamoto, Shintaro
Uemura, Makiko
Perforation in an intestinal malignant lymphoma case
title Perforation in an intestinal malignant lymphoma case
title_full Perforation in an intestinal malignant lymphoma case
title_fullStr Perforation in an intestinal malignant lymphoma case
title_full_unstemmed Perforation in an intestinal malignant lymphoma case
title_short Perforation in an intestinal malignant lymphoma case
title_sort perforation in an intestinal malignant lymphoma case
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4906586/
https://www.ncbi.nlm.nih.gov/pubmed/27297406
http://dx.doi.org/10.1186/s13104-016-2111-6
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