A CASE DIAGNOSED AS MALIGNANT LYMPHOMA OF THE ILEUM CAUSING INTUSSUSCEPTION BY ABDOMINAL ULTRASONOGRAPHY AND CT

We present a case of primary malignant lymphoma of the ileum with intussusception diagnosed by abdominal ultrasonography, CT and Ba enema studies preoperatively. A 53-year-old man visited our hospital because of abdominal pain. Blood laboratory data indicated anemia (Hb 10.7g/dl), but CEA and CA19-9 as tumor markers were in normal range. Abdominal ultrasonography revealed the Target sign and Hay forksign of intussusception. Abdominal CT revealed an intussusception ranging 12cm from the ileocecal region to the ascending colon. We suspected a tumor leading the intussusception. Ba enema studies revealed a defect like a cancer nail, with ileo-colic type intussusception. We suspected submucosal tumor of the ileum due to a smooth surface defect in the lead by Ba enema studies. Under a diagnosis of intussusception caused by ileal tumor, an operation was performed. Ileo-cecectomy and lymph node dissection were done due to supra-mesentric lymph node swelling. A tumor 5.1×3.5×1.8cm in diameter existed in the ileum about 40cm oral from the Bauhin valve. We diagnosed it as diffuse medium-sized type B cell non-Hodgkin's lymphoma pathologically. Chemotherapy with CHOP 4 times was given. He is doing well with no recurrence to date.