Analysis of the Misdiagnosis of Primary Small Intestine Lymphoma in 14 Cases

SHI Nan; LIU Dian-ming; LIANG Hui; PU Ya-bin; NIE Ming-ming; WEI Guo; XUE Xu-chao; FANG Guo-en; WU Jian-guo

doi:10.3969/j.issn.1002-3429.2018.07.014

Abstract：Objective To investigate the causes of misdiagnosis and preventive measures for primary small intestine lymphoma ( PSIL) . Methods The data of 14 misdiagnosed cases of PSIL who received treatment in De-partment of General Surgery, the 455 Hospital of PLA and Changhai Hospital from June 2004 to June 2016 were ana-lyzed retrospectively. Results Patients in this group accounted for 18. 4% (14/76) of all the patients admitted to the two hospitals during the same period. Abdominal pain was found in 14 cases, intestinal obstruction in 5 cases, gastrointestinal bleeding in 4 cases, palpable abdominal mass in 3 cases, and acute diffuse peritonitis in 2 cases. The number of patients who underwent abdominal color Doppler ultrasound, abdominal CT examination,digestive endosco-py and positron emission computed tomography was 14, 12, 5 and 1, respectively. However, all were not diagnosed clearly. The numbe of patients who were misdiagnosed as Crohn disease, intestinal tuberculosis, small bowel cancer, small intestinal stromal tumor and cecal cncer was 5, 4, 3,1 and 1, respectively. Surgical treatment was performed in 14 cases, radical resection in 10 and palliative operation in 4. Postoperative pathological examination confirmed PSIL, including 13 cases of non-Hodgkin's lymphoma ( 10 cases of B-cell and 3 cases of T-cell) and 1 case of Hodgkin lymphoma. After 1-10 years of follow-up, 5 cases were lost to follow-up and only 1 survived. Conclusion The clinical and imaging findings of PSIL are not specific. PSIL should be suspected in terms of small intestinal mass in the early stage of abdominal CT, with acute intestinal obstruction, acute diffuse peritonitis and gastrointestinal bleeding, which can be confirmed by means of pathological examinations.