Presentation Information
[INTS3-6]Burkitt lymphoma presenting as intestinal obstruction in a patient with long-standing indolent squamous cell carcinoma: a case report on a diagnostic pitfall in surgical oncology
*Jaram Lee1, Joo Yeon Koo2, Soo Young Lee1, Hyeung-min Park1, Chang Hyun Kim1, Hyeong Rok Kim1 (1. Department of surgery, Chonnam national university hwasun hosipital, Republic of Korea, 2. Department of pathology, Chonnam national university hwasun hosipital, Republic of Korea)
Background
New lesions in patients with long-standing malignancies are often attributed to disease progression. However, this assumption may obscure the diagnosis of a newly emerging, biologically distinct cancer. We report a case illustrating a diagnostic pitfall in surgical oncology, in which an aggressive lymphoma presented unexpectedly in a patient with a prolonged history of indolent squamous cell carcinoma.
Case presentation
A 53-year-old man with a nearly 20-year history of multifocal, well-differentiated cutaneous and anogenital squamous cell carcinoma presented with acute abdominal pain. Contrast-enhanced abdominopelvic computed tomography demonstrated ileocecal intussusception with fluid-filled dilatation of the small bowel loops, consistent with partial intestinal obstruction. Enlarged lymph nodes were noted in the right inguinal and external iliac chains; no paraaortic or aortocaval lymphadenopathy, hepatosplenomegaly, or ascites was identified. Given the progressive obstructive symptoms, emergency surgery was performed. Ileocecectomy revealed a subepithelial mass in the terminal ileum serving as the lead point of intussusception. Histopathologic examination demonstrated Burkitt lymphoma, characterized by CD20, CD10, and BCL6 positivity, high c-Myc expression, and a Ki-67 proliferation index of approximately 90%. Simultaneous right inguinal lymph node dissection revealed metastatic squamous cell carcinoma.
Conclusions
This case highlights an important diagnostic pitfall in surgical oncology: new clinical events and imaging abnormalities in patients with long-standing indolent malignancies should not be automatically attributed to progression of the known disease. Integrated interpretation of preoperative imaging, surgical findings, and histopathology is essential for identifying unexpected, biologically distinct malignancies and ensuring appropriate multidisciplinary management.
New lesions in patients with long-standing malignancies are often attributed to disease progression. However, this assumption may obscure the diagnosis of a newly emerging, biologically distinct cancer. We report a case illustrating a diagnostic pitfall in surgical oncology, in which an aggressive lymphoma presented unexpectedly in a patient with a prolonged history of indolent squamous cell carcinoma.
Case presentation
A 53-year-old man with a nearly 20-year history of multifocal, well-differentiated cutaneous and anogenital squamous cell carcinoma presented with acute abdominal pain. Contrast-enhanced abdominopelvic computed tomography demonstrated ileocecal intussusception with fluid-filled dilatation of the small bowel loops, consistent with partial intestinal obstruction. Enlarged lymph nodes were noted in the right inguinal and external iliac chains; no paraaortic or aortocaval lymphadenopathy, hepatosplenomegaly, or ascites was identified. Given the progressive obstructive symptoms, emergency surgery was performed. Ileocecectomy revealed a subepithelial mass in the terminal ileum serving as the lead point of intussusception. Histopathologic examination demonstrated Burkitt lymphoma, characterized by CD20, CD10, and BCL6 positivity, high c-Myc expression, and a Ki-67 proliferation index of approximately 90%. Simultaneous right inguinal lymph node dissection revealed metastatic squamous cell carcinoma.
Conclusions
This case highlights an important diagnostic pitfall in surgical oncology: new clinical events and imaging abnormalities in patients with long-standing indolent malignancies should not be automatically attributed to progression of the known disease. Integrated interpretation of preoperative imaging, surgical findings, and histopathology is essential for identifying unexpected, biologically distinct malignancies and ensuring appropriate multidisciplinary management.