case_images: PMC4508281_01
case_images: Preoperative images. a Ultrasonography showed the "target sign" in the lower abdomen. b Enhanced CT revealed ileocolic intussusception and stretched mesenteric vessels. c The outer wall of the area of intussusception consisted of an edematous ileum (inner layer; black arrow) and dilated colon (outer layer; white arrow). d An enema examination showed "crab's claw sign" in the transverse colon.
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case_images: Fig1
case_images: An ultrasonography examination of the abdomen showed a target sign at the lower abdomen, indicating the existence of intussusception (Figure 1). Enhanced computed tomography (CT) also revealed ileocolic intussusception with a suspicious looking mass (Figure 1). An attempt at hydrostatic reduction with gastrografin  (Bayer Yakuhin, Osaka, Japan) was not successful (Figure 1); therefore, an emergent operation was conducted.
case_images: Abdominal CT at previous clinic. This CT was performed 5 weeks before he admitted to our hospital. Retrospectively, intussusception could be pointed out (arrow).
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case_images: Fig2
case_images: In addition, an examination of abdominal CT performed at the previous clinic 5 weeks earlier made us suspicious of signs of ileocolic intussusception (Figure 2).
case_images: Intraoperative findings. a Ileocolic intussusception was confirmed. Laparoscopic reduction failed. b The mesentery was markedly thickened, and the ileum was edematous. Although the tumor (arrow) in the terminal ileum was partially reduced, manual reduction was unsuccessful. Ileocecal resection was performed.
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case_images: Fig3
case_images: Initially, we performed probe laparoscopy, which revealed ileocolic intussusception, serous ascites and a markedly edematous ileum and mesentery (Figure 3).
case_images: Resected specimen. a The tumor (black arrow) was located on the antimesenteric side 2 cm oral to the ileocecal valve. The mucosa of the ileum was markedly edematous and erosive (arrowhead). b The tumor was hard and contained a white section. The shape of the tumor was distorted, especially in the ileal serosa.
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case_images: Fig4
case_images: In the resected specimen, a 3 cm submucosal firm mass was found 2 cm oral from the ileocecal valve (Figure 4). In contrast, immunostaining for CD3 (data not shown), TdT (Figure 4d), CD34, CD23 and cyclin D1 was negative (data not shown).
case_images: Representative histological images of the tumor cells in the resected specimen. a Hematoxylin-eosin (HE) stain. b-d Immunohistochemistry. b CD20. c BCL2. d TdT. Positive cells stained brown on immunohistochemistry. Original magnification x400. Bar 50 mum.
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case_images: Fig5
case_images: Histologically, the ileocecal mass was composed of the transmural diffuse proliferation of medium- to large-sized lymphoid cells (Figure 5a). Immunohistochemistry revealed that the tumor cells were positive for CD20 (Figure 5b), CD79a (data not shown) and Bcl-2 (Figure 5c).