S3741 When the Cecum Hides a Lymphoma: A Diagnostic Challenge

Introduction: Large B-cell lymphoma (LBCL) of the colon is the most common non-Hodgkin’s lymphoma, although it only accounts for 0.2% to 1% of colonic malignancy. Prognosis is generally very poor once found and given the rarity of the disease, there is a lack of standardized clinical treatment. Additionally, given the non-specific symptoms with which patients can present, early diagnosis can be challenging, often mimicking colorectal carcinoma. Imaging and histopathology are essential for accurate diagnosis, often requiring surgical intervention for definitive tissue sampling ¹² Herein we present a case of an otherwise healthy 69 year old man who presented with abdominal pain and coffee-ground emesis whose workup eventually led to the discovery of cecal lymphoma. Case Description/Methods: Patient is a 69-year-old man with no significant past medical history who was transferred via Jet ICU from a cruise due concerns for small bowel obstruction. For 4 days prior to presentation, the patient was with reports of mid-epigastric pain with associated nausea and coffee-ground emesis and imaging on the ship revealed findings concerning for obstruction. Once admitted, abdominal Computerized Tomography (CT) revealed a large 8 cm partially obstructing cecal mass. EGD was performed with findings of LA Grade C esophagitis. Patient was discharged as he had pre-established care with GI in his hometown. Colonoscopy there revealed a large cecal mass and biopsy was positive for Diffuse Large B-cell lymphoma. Patient underwent surgical resection and subsequent management with oncology. Several months later the patient and his wife informed us he was doing well, and the treating physicians were pleased with prompt management and guidance of our team. Discussion: Lymphoma of the colon is rare and often a diagnostic and therapeutic challenge given the difficulty in diagnosis and lack of treatment standardization. Currently, treatments range between chemotherapy with R-CHOP with or without surgical interventions depending on associated complications such as obstruction or perforation. Ongoing challenges include distinguishing lymphoma from other GI malignancies and optimizing therapy in elderly or immunocompromised patients. Our case highlights the need for ongoing research needed for more diagnostic and therapeutic guidance especially in otherwise healthy patients.