Gastrointestinal Perforation Complicates Management of Mantle Cell Lymphoma

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Colored scanning electron micrograph (SEM) of a lymphoma cell.
Colored scanning electron micrograph (SEM) of a lymphoma cell.

Patients undergoing therapy for mantle cell lymphoma (MCL) with abdominal lymphadenopathy, or those undergoing treatment with history of abdominal lymphoma, and their caregivers should be made aware of the symptoms of gastrointestinal perforation to ensure they seek timely treatment, the authors of a patient case published in Case Reports in Oncology have suggested.

Mantle cell lymphoma, a rare form of non-Hodgkin lymphoma (NHL), is the cause of 2.8% of all NHL cases in the United States. In most cases, patients present with advanced disease including extranodal involvement in 10% to 20% of cases at diagnosis. The disease is more likely to develop in patients who are male (2:1 ratio) and older (median age at diagnosis, 68 years). Pathogenesis is driven by a single chromosomal translocation t(11;14))(q13;q32) that results in overexpression of cyclin D1 protein.

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Gastrointestinal perforation often complicates management of gastrointestinal lymphomas. Significant morbidity from peritonitis and sepsis prolong hospitalization and delay further medical treatment. Approximately 9% of patients with gastrointestinal lymphoma experience GI perforation. Of these, 49% occurred concurrently with chemotherapy, and most commonly with R-CHOP. However, gastrointestinal lymphoma-associated perforations rarely occur less than 2 days after initiating chemotherapy, but approximately 48% occur within the first month of treatment.

In this case, a 55-year-old male patient presented to the emergency department complaining of nausea, vomiting, and abdominal discomfort, and reported an unintentional weight loss of 18 kg over 6 months. Hematemesis, constipation, diarrhea, hematochezia, and melena were denied. He reported no previous medical history, no family history of malignancy, and denied any history of alcohol or illegal drug use.

Notable findings on assessment included: cachexia with bi-temporal wasting, a palpable mass in his right upper quadrant without rebound tenderness or distension, notable lymphadenopathy bilaterally in both anterior and posterior cervical lymph nodes (all less than 1 cm), and bilateral inguinal lymphadenopathy. The patient had no pedal edema, and no focal neurologic deficits.  

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