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Background <p>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 in which acute intestinal obstruction was caused by high-grade B-cell lymphoma with features suggestive of Burkitt lymphoma in a patient with a prolonged history of multifocal squamous cell carcinoma.</p> Case presentation <p>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 were 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 B-cell lineage malignant lymphoma favoring Burkitt lymphoma. Immunohistochemical staining showed positivity for leukocyte common antigen, CD20, CD79a, CD10, and BCL6, negativity for cytokeratin, CD3, BCL2, CD30, and EBER in situ hybridization, c-Myc expression in approximately 80% of tumor cells, and a Ki-67 proliferation index of approximately 90%. FISH analysis for MYC, BCL2, and BCL6 rearrangements was not available. Simultaneous right inguinal lymph node dissection revealed metastatic squamous cell carcinoma.</p> Conclusions <p>This case underscores the importance of longitudinal imaging assessment and histopathologic confirmation when new acute abdominal events arise in patients with a history of malignancy. Even when nodal disease is attributable to a known cancer, a newly developed intestinal lesion may represent a biologically distinct malignancy. Integrated radiologic, surgical, pathologic, and multidisciplinary evaluation is essential for comprehensive diagnosis and appropriate patient care.</p>

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High grade B cell lymphoma with features suggestive of Burkitt lymphoma presenting as intestinal obstruction in a patient with long standing squamous cell carcinoma

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月1日

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  • Jaram Lee,
  • Joo Yeon Koo,
  • Soo Young Lee,
  • Hyeung-min Park,
  • Chang Hyun Kim,
  • Hyeong Rok Kim

摘要

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 in which acute intestinal obstruction was caused by high-grade B-cell lymphoma with features suggestive of Burkitt lymphoma in a patient with a prolonged history of multifocal 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 were 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 B-cell lineage malignant lymphoma favoring Burkitt lymphoma. Immunohistochemical staining showed positivity for leukocyte common antigen, CD20, CD79a, CD10, and BCL6, negativity for cytokeratin, CD3, BCL2, CD30, and EBER in situ hybridization, c-Myc expression in approximately 80% of tumor cells, and a Ki-67 proliferation index of approximately 90%. FISH analysis for MYC, BCL2, and BCL6 rearrangements was not available. Simultaneous right inguinal lymph node dissection revealed metastatic squamous cell carcinoma.

Conclusions

This case underscores the importance of longitudinal imaging assessment and histopathologic confirmation when new acute abdominal events arise in patients with a history of malignancy. Even when nodal disease is attributable to a known cancer, a newly developed intestinal lesion may represent a biologically distinct malignancy. Integrated radiologic, surgical, pathologic, and multidisciplinary evaluation is essential for comprehensive diagnosis and appropriate patient care.