Primary intestinal lymphoma.

A 52 year old man had been complained of abdominal pain during the last 4-month. The pain was located in the upper left quadrant and it radiated to the epigastrium. It increased when eating and was accompanied by asthenia, anorexia and 3 kg weight loss. The patient did not report melena, rectal bleeding, fever or evening sweating. On physical examination, lymph nodes were not observed. A large and hard mass was palpable in mesogastrium. The analysis showed iron deficiency anemia with no other data of interest, and an ultrasonographic study showed a mass in the splenic flexure, with the transverse colon and descending colon apparently involved; it was compatible with colon cancer as first possibility. A colonoscopy was performed: At 60 cm from the anus, an approximately 4-5 cm in diameter lesion was seen, which had a preserved and highly vascularized mucosa, and that was suggestive of extrinsic compression or submucosal tumor (Fig. 1). Biopsies were taken, and they were reported as consistent with diffuse large B cell non-Hodgkin’s lymphoma. Aspirate and bone marrow biopsies were also performed, being normal. Finally, a chest and abdominal-pelvic CT revealed a 11x 16 cm inframesocolic mass that compressed the transverse colon and infiltrated the jejunum, forming an aneurysmatic loop with a large necrotic component. It began a chemotherapy treatment, but one month later the patient was operated on because of a jejunal perforation.