Acute Appendicitis in a Man Undergoing Therapy for Mantle Cell Lymphoma

A 71-year-old man was diagnosed with an aggressive mantle cell lymphoma and was started on six cycles of R-CHOP chemotherapy. Approximately two weeks after starting his first cycle of chemotherapy, he complained of severe right lower quadrant abdominal pain, and an abdominal CT scan demonstrated an enlarged appendix with evidence of contained perforation. The man underwent open appendectomy for acute appendicitis and recovered. The appendectomy specimen was submitted for routine pathological analysis. There was histologic evidence of perforation in association with an inflammatory infiltrate with fibrin adhered to the serosal surface; scattered small lymphoid aggregates were present on the mucosal surface. Although the lymphoid aggregates in the submucosa and lamina propria were rather unremarkable by routine histologic examination, immunohistochemistry revealed the lymphocytes to be predominantly Cyclin D1-overexpressing B cells. To our knowledge, this is the first reported case of acute appendicitis in association with appendiceal involvement by mantle cell lymphoma.

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Mantle Cell Lymphoma Presenting as Acute Abdominal Syndrome: A Rare Case Report and Literature Review

Healthcare ◽

10.3390/healthcare9081000 ◽

2021 ◽

Vol 9 (8) ◽

pp. 1000

Author(s):

Fu-Chou Lee ◽

Junn-Liang Chang ◽

Hung-Ming Chen ◽

Wan-Chen Tsai ◽

Po-Jen Hsiao

Keyword(s):

Acute Appendicitis ◽

B Cell ◽

Cyclin D1 ◽

Mantle Cell Lymphoma ◽

Cell Lymphoma ◽

B Cell Lymphomas ◽

Lower Quadrant ◽

Mantle Cell ◽

Hodgkin's Lymphomas ◽

Right Lower Quadrant

Background: Acute abdominal syndrome can be caused by several possible reasons. The most common causes are perforation of a gastroduodenal ulcer, peritonitis, intestinal obstructions, and perforation of an appendix or fallopian tube. Fever and pain can be caused by an appendicitis or sigmoiditis. Appendiceal lymphoma is a rare disease that is usually found incidentally during appendectomy. Most of the cases are non-Hodgkin’s lymphomas. Mantle cell lymphoma is an aggressive B-cell non-Hodgkin’s lymphoma with a poorer prognosis than other B-cell lymphomas; thus, a definitive diagnosis is essential. Case Summary: A 60-year-old man presented with right lower quadrant pain. He denied any nausea, vomiting or anorexia and was afebrile. The physical examination revealed right lower quadrant abdomen tenderness. The computed tomography scan revealed periappendiceal fatty stranding with a swollen appendix, approximately 2 cm in diameter and prominent paraaortic, portacaval and mesenteric lymph nodes. A diagnosis of acute appendicitis was made, and laparoscopic appendectomy was performed immediately. The subsequent pathological examination revealed severe congestion with lymphoid hyperplasia. The immunohistochemistry stains revealed positive staining for cluster of differentiation (CD) CD20, B-cell lymphoma-2 (Bcl-2), cyclin D1, SRY-box transcription factor-11 (SOX-11), immunoglobulin D (IgD) and immunoglobulin M (IgM) but negative staining for CD3, CD5, CD10 and CD23. 18F-FDG positron emission tomography showed peripheral lymph node involvement, while the bone marrow biopsy showed negative findings. Therefore, a diagnosis of mantle cell lymphoma, Ann Arbor stage IVA, was made. The patient received postoperative combination chemotherapy and remained in a stable condition over a 1-year follow-up period. Conclusion: We report an uncommon case that initially presented as acute appendicitis, for which a final diagnosis of mantle cell lymphoma was made. In comparison with other B-cell lymphomas, mantle cell lymphoma has a poorer prognosis, and positive immunochemical staining of cyclin D1 and SOX-11 is useful for differentiating mantle cell lymphoma from other appendiceal lymphomas and treating patients appropriately. Physicians and nursing staff should be also aware of the associated complications and management in these patients.

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Rare presentation of ileocolic intussusception secondary to mantle cell lymphoma

BMJ Case Reports ◽

10.1136/bcr-2019-229425 ◽

2019 ◽

Vol 12 (8) ◽

pp. e229425

Author(s):

Veeresh Aukhojee ◽

Creski M Gilong ◽

Gayatri Seewoogoolam ◽

Paul N Strauss

Keyword(s):

Mantle Cell Lymphoma ◽

Cell Lymphoma ◽

Adult Population ◽

Right Hemicolectomy ◽

Sudden Onset ◽

Hepatic Flexure ◽

Ileocolic Intussusception ◽

Abdominal Ct ◽

Rare Presentation ◽

Mantle Cell

Mantle cell lymphoma is a type of B-cell non-Hodgkin’s lymphoma (NHL) and accounts for 3%–6% of all adult NHL.1 2 Bowel intussusception secondary to lymphoma is rare in adults, accounting for only 4% of all cases.3The authors present the case of a 53-year-old man, recently diagnosed with mantle cell lymphoma, who presented with sudden onset right-sided abdominal pain and was found to have ileocolic intussusception up to the hepatic flexure on abdominal CT. He underwent an emergency right hemicolectomy and intraoperatively, the terminal ileum could be seen telescoping into the caecum, up to the hepatic flexure. Although intussusception is uncommon in the adult population, an underlying bowel pathology should always be considered and prompt imaging should be organised to confirm the diagnosis and allow initiation of management in a timely manner.

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Acute Appendicitis in Pregnant Women: Our Clinical Experience

Clinical & Investigative Medicine ◽

10.25011/cim.v39i6.27521 ◽

2016 ◽

Vol 39 (6) ◽

pp. 159 ◽

Cited By ~ 2

Author(s):

Ahmet Türkan ◽

Metin Yalaza ◽

Mehmet Tolga Kafadar ◽

Gürka Değirmencioğlu

Keyword(s):

Abdominal Pain ◽

Surgical Treatment ◽

Acute Appendicitis ◽

Pregnant Women ◽

Laparoscopic Appendectomy ◽

Open Appendectomy ◽

Fetal Loss ◽

University Research ◽

Lower Quadrant ◽

Right Lower Quadrant

Purpose: The purpose of this study was to analyse 13 patients who were treated in our clinic due to acute appendicitis during pregnancy. Methods: Records of the patients who received appendectomy with appendicitis diagnosis in our Turgut Özal University Research and Application Hospital between January 2007 and December 2015 have been analyzed retrospectively. Results: Appendectomies were performed on 13 pregnant patients with an acute appendicitis diagnosis. Average age of the patients was 27.69 years (between 22-37 years). Most frequent complaint of the patients was abdominal pain and most frequent examination finding was tenderness at right lower quadrant. Ultrasonography was used in all cases for diagnosis. Surgery was decided with clinical diagnosis for five cases (38.5%) where appendix had not been identified with ultrasonography. While laparoscopic appendectomy was applied in one case (7.7%) and open appendectomy was applied using a McBurney incision in 12 cases (92.3%). Average hospitalization duration was 1.69 days. All patients were tracked together through the Gynaecology Department for two weeks after they had been discharged from the hospital. Preterm delivery, maternal and fetal loss did not occur. Conclusion: It is considered appropriate to apply ultrasonography routinely to all pregnant patients in whom acute appendicitis is suspected. Concern for maternal or fetal complication that may occur in consequence of an unnecessary surgery should not be at a level that will delay surgical treatment needed by the patient.

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Cecal Epiploic Appendagitis: A Diagnostic and Therapeutic Dilemma

The American Surgeon ◽

10.1177/000313480707300821 ◽

2007 ◽

Vol 73 (8) ◽

pp. 828-830 ◽

Cited By ~ 4

Author(s):

Vijaykumar G. Patel ◽

Arundathi Rao ◽

Reginald Williams ◽

Radha Srinivasan ◽

James K. Fortson ◽

...

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Ct Scan ◽

Abdominal Ct ◽

Lower Quadrant ◽

Radiographic Findings ◽

Epiploic Appendagitis ◽

Abdominal Symptoms ◽

Abdominal Ct Scan ◽

Limiting Condition

Acute epiploic appendagitis (EA) is a rare and often misdiagnosed cause of acute abdominal pain. Though a benign and often self-limiting condition, EA's ability to mimic other disease processes makes it an important consideration in patients presenting with acute abdominal symptoms. Careful evaluation of abdominal CT scan findings is crucial in the accurate diagnosis of epiploic appendagitis, thus avoiding unnecessary surgical intervention. We report a case of a 29-year-old male presenting with a two day history of generalized abdominal pain. Physical exam revealed a diffusely tender abdomen with hypoactive bowel sounds. The patient had a leukocytosis of 18,000 and abdominal CT scan revealed right lower quadrant inflammatory changes suggestive of acute appendicitis. Laparoscopic exploration revealed an inflamed gangrenous structure adjacent to the ileocecal junction. Pathologic evaluation revealed tissue consistent with epiploic appendagitis. Retrospective review of the CT scan revealed a normal appearing appendiceal structure superolateral to the area of inflammation. The patient recovered uneventfully with resolving leukocytosis. We present a case of cecal epiploic appendagitis mimicking acute appendicitis and review the current literature on radiographic findings, diagnosis, and treatment of this often misdiagnosed condition. General surgeons should be aware of this self-limiting condition and consider this in the differential diagnosis.

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A new technique for the diagnosis of acute appendicitis: abdominal CT with compression to the right lower quadrant

European Radiology ◽

10.1007/s00330-016-4728-1 ◽

2017 ◽

Vol 27 (8) ◽

pp. 3317-3325 ◽

Cited By ~ 3

Author(s):

Abidin Kılınçer ◽

Erhan Akpınar ◽

Bülent Erbil ◽

Emre Ünal ◽

Ali Devrim Karaosmanoğlu ◽

...

Keyword(s):

Acute Appendicitis ◽

New Technique ◽

Abdominal Ct ◽

Lower Quadrant ◽

A New Technique ◽

The Right ◽

Right Lower Quadrant

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Mantle cell lymphoma presenting as acute appendicitis

International Journal of Surgery Case Reports ◽

10.1016/j.ijscr.2014.10.068 ◽

2015 ◽

Vol 6 ◽

pp. 33-35 ◽

Cited By ~ 2

Author(s):

Max Chae ◽

Sampath Kumar ◽

Muhammad Cheema

Keyword(s):

Acute Appendicitis ◽

Mantle Cell Lymphoma ◽

Cell Lymphoma ◽

Mantle Cell

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Abdominal CT Scanning in Reproductive-Age Women with Right Lower Quadrant Abdominal Pain: Does Its Use Reduce Negative Appendectomy Rates and Healthcare Costs?

The American Surgeon ◽

10.1177/000313480707300609 ◽

2007 ◽

Vol 73 (6) ◽

pp. 580-584 ◽

Cited By ~ 4

Author(s):

Bryan C. Morse ◽

Richard H. Roettger ◽

Corey A. Kalbaugh ◽

Dawn W. Blackhurst ◽

William B. Hines

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Ct Scanning ◽

Reproductive Age ◽

Negative Appendectomy ◽

Abdominal Ct ◽

Lower Quadrant ◽

Quadrant Abdominal Pain ◽

Reproductive Age Women ◽

Right Lower Quadrant

Although acute appendicitis is the most frequent cause of the acute abdomen in the United States, its accurate diagnosis in reproductive-age women remains difficult. Problems in making the diagnosis are evidenced by negative appendectomy rates in this group of 20 per cent to 45 per cent. Abdominal CT scanning has been used in diagnosing acute appendicitis, but its reliability and usefulness remains controversial. There is concern that the use of CT scanning to make this diagnosis leads to increased and unwarranted healthcare charges and costs. The purpose of our study is to determine if abdominal CT scanning is an effective test in making the diagnosis of acute appendicitis in reproductive-age women (age, 16–49 years) with right lower quadrant abdominal pain and to determine if its use is cost-effective. From January 2003 to December 2006, 439 patients were identified from our academic surgical database and confirmed by chart review as undergoing an appendectomy with a pre- or postoperative diagnosis of acute appendicitis. Data, including age, presence and results of preoperative abdominal CT scans, operative findings, and pathology reports were reviewed. Comparison of patients receiving a preoperative CT scan with those who did not was performed using chi-squared analysis. In the subgroup of reproductive-age women, there was a significant difference in negative appendectomy rates of 17 per cent in the group that received abdominal CT scans versus 42 per cent in the group that did not ( P < 0.038). After accounting for the patient and insurance company costs, abdominal CT scan savings averaged $1412 per patient. Abdominal CT scanning is a reliable, useful, and cost-effective test for evaluating right lower quadrant abdominal pain and making the diagnosis of acute appendicitis in reproductive-age women.

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Omental infarction following colonoscopy

Journal of Digestive Endoscopy ◽

10.4103/0976-5042.159243 ◽

2015 ◽

Vol 06 (02) ◽

pp. 073-075

Author(s):

Antonio Gangemi ◽

Aqsa Durrani ◽

Brian R. Boulay

Keyword(s):

Abdominal Pain ◽

Ct Scan ◽

Acute Abdominal Pain ◽

Abdominal Ct ◽

Lower Quadrant ◽

Omental Infarction ◽

Abdominal Ct Scan ◽

The Right ◽

Inflammatory Changes ◽

Right Lower Quadrant

AbstractDiagnosis of omental infarction, while rare, has become increasingly common likely due to improvements in diagnostic imaging. Reported incidence of omental infarction varies; however, omental infarction has not yet been described in association with colonoscopy. Common complications of colonoscopy include complications of sedation, complications of bowel preparation, and bleeding following polypectomy, and rarely, perforation or infection. We describe herein a case of a 63-year-old female who developed acute right lower quadrant abdominal pain following a colonoscopy. Abdominal computed tomography (CT) scan revealed omental infarction in the right lower quadrant. Conservative management was employed, and the patient was observed for resolution of symptoms. Repeat abdominal CT scan 2 weeks following initial presentation showed resolution of inflammatory changes associated with omental infarction. The patient also improved clinically. Omental infarction should be considered in patients presenting with acute abdominal pain following colonoscopy.

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