Prevention and treatment of ileocecal lymphoma

Lymphoma is a malignant tumor that originates in lymph nodes or lymphatic tissue, with massive proliferation of lymphocytes and/or tissue cells, and the degree of malignancy varies. Because lymphoma can occur in lymphoid tissue throughout the body, its early clinical manifestations lack specificity and can be easily misdiagnosed as other common diseases in the early stages. Ileocecal lymphoma is easily misdiagnosed as periappendiceal abscess. This case is relatively rare in clinical practice and clinicians are not aware of it enough. We summarized the diagnosis and treatment of a patient with ileocecal malignant lymphoma to deepen our understanding of digestive system lymphoma and to identify patients with atypical clinical manifestations to avoid delays in treatment.

Prevention and control measures

Prevention of ileocecal lymphoma (1) In clinical practice, patients with prolonged right lower abdominal pain, metastatic right lower abdominal pain, or right lower abdominal mass, with or without fever, should be considered to have this disease and should not be easily diagnosed as appendicitis or periappendiceal abscess.

(2) If the diagnosis is appendicitis or periappendiceal abscess and a tumor cannot be ruled out, one should not rely solely on the results of imaging examinations or endoscopic biopsy. If the patient's symptoms and signs do not match, a tumor puncture biopsy can be performed to clarify the nature of the tumor.

(3) If a mass is found in the ileocecal region during surgery and the disease cannot be ruled out, it is not appropriate to simply remove the appendix. Careful exploration should be carried out to observe whether there are enlarged lymph nodes in the mesentery, and suspicious tissue should be removed and frozen to avoid delaying diagnosis and treatment.

(4) If the patient still experiences recurrent right lower abdominal pain, a right lower abdominal mass, or recurrent fever after appendectomy, B-mode ultrasound, CT, or colonoscopy should be performed. If the disease is highly suspected before surgery, a puncture biopsy can be performed for pathological examination to rule out the possibility of ileocecal malignancy.

The current treatment for ileocecal lymphoma advocates the use of comprehensive treatment with surgery as the main method. The primary tumor and nearby lymph nodes should be removed more thoroughly. Postoperative radiotherapy and chemotherapy can achieve good long-term therapeutic effects. Radical resection is the most ideal method for treating patients with gastrointestinal malignant lymphoma. Patients who cannot undergo radical resection should undergo palliative surgery as much as possible to improve their quality of life. For patients whose tumors are found to be at a later stage during surgery, conventional chemotherapy is recommended after surgery. Postoperative adjuvant chemotherapy is an important method to control and eliminate residual and micro-metastatic lesions. This disease is sensitive to chemotherapy and appropriate chemotherapy should be received regardless of whether surgery is performed or not. During the diagnosis and treatment process, the patient's long-term fever, right lower abdominal pain, and right lower abdominal mass were not taken seriously enough, and no puncture pathological diagnosis of the abdominal mass was performed, which delayed the diagnosis. The diagnostic thinking should not be limited to common and frequently occurring diseases. The medical history should be carefully inquired and the physical examination should be performed carefully. At the same time, characteristic imaging data should be combined to make a clear diagnosis as soon as possible, use medication in time, improve prognosis, and avoid serious consequences after the disease worsens.

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