A 67-year-old female patient with type 2 diabetes mellitus, who began suffering from vomiting, abdominal pain and intolerance to solid foods 18 months prior to hospitalization, was referred to the National Cancer Institute.
Upon admission, the patient was afflicted with coughing, with faces of pain, anti-algic position, Karnofsky index of 80% and CS 1.
On physical examination the abdomen was distended and a tumor was located in the left hemiabdomen without hepatomegaly or adenopathies.
A computed tomography (CT) scan of the pelvis showed a tumor of lobulated aspect in the distal third of the ileum, with thickening of the wall, stenosis of the lumen and extension to the ileum.
She was scheduled for exploratory laparotomy with resection of the ileum segment and end-to-end anastomosis.
The transoperative diagnosis was lymphoma.
For the a-mopathological study, a segment of ileum measuring 8x8x6 cm was received with an ulcerated nodular tumor, irregular ulcerated, measuring 18x8x6 cm border to serosa.
Histological examination revealed a malignant neoplasm consisting of large cells, diffusely arranged.
The cells had ovoid nuclei, occasionally healed, with apparent chromatin and nucleolus.
There was marked atypia and pleomorphism, as well as binucleated cells.
A remarkable feature was the background rich in lymphocytes, neutrophils, eosinophils and occasional plasma cells.
We performed an immunohistochemical study using the standard method streptavidin-biotin-peroxidase.
Signaling cells expressed CD 45, CD 68 and lysozyme, which supported the diagnosis of HS.
Lymphocytes were predominantly colonized with a T lineage study where cells with lobulated ovoid nucleus, granular chromatin and apparent nucleolus were observed.
The cytoplasm of cells contained endoplasmic reticulum, lysosomes and mitochondria.
The patient recovered satisfactorily and was discharged in January 2007.
In May 2007 whole-body PET-CT was performed, which reported tumor activity in mesenteric and retroperitoneal ganglia and a multilobulated abdominal tumor located between the right anterior rectus and parietal peritoneum.
An exploratory laparotomy was programmed with block resection of the implant of the abdominal wall and ileum segment with selective dissection of retroperitoneal lymph nodes.
The histological study of the small intestine segment and lymph nodes showed morphological characteristics and immunohistochemical profile similar to those described in the primary tumor.
It was decided to administer 6 cycles of chemotherapy with CHOP scheme (acquired fever, doxorubicin, vincristine and prednisone).
The patient currently shows a complete clinical response.
