Year 2024 / Volume 116 / Number 9
Letter
Intestinal stenosis developed after a complete response to chemotherapy in a patient with Crohn’s disease and lymphoma of the jejunum

502-504

DOI: 10.17235/reed.2023.10004/2023

Marta García Calonge, Fernando Fernández Cadenas, Helena González Sánchez, Daniel Muíño-Domínguez, Lucía Morais Bras, Mateo García Ramos, Lourdes Sanz Álvarez, Sabino Riestra,

Abstract
An increased risk of hematologic malignancies secondary to long-term immunomodulators and biologics has been described in patients with inflammatory bowel disease1. Here, we present a case of jejunal stricture after chemotherapy treatment in a patient with ileal Crohn´s disease (CD) and jejunal lymphoma. The patient was a 32-year-old male with ileal CD in remission presenting with abdominal pain and distension. Abdominal computed tomography (CT) showed a poorly defined mass in the proximal jejunum, and positron emission tomography (PET) – CT showed hypermetabolic activity at that level. An upper endoscopy evidenced an indurated, friable circumferential mass causing a significant reduction of the intestinal lumen. Histological and cytometry findings led to a diagnosis of large B cell lymphoma, for which the patient received standard treatment (R-CHOP and IPI), achieving complete response. Eight months later, the patient reported abdominal pain and distention. Abdominal CT showed a thickening of a short segment of the proximal jejunum. An upper endoscopy showed a punctiform stenosis, while multiple biopsies showed neither histological recurrence of lymphoma nor signs of IBD. The patient was diagnosed with a post-chemotherapy stricture and underwent progressive endoscopic balloon dilatation. He finally was scheduled for laparoscopic small bowel resection. An histological analysis of the surgical piece revealed a granulomatous reaction with multinucleated foreign body-like giant cells, without evidence of malignancy (recurrence of lymphoma) nor inflammatory infiltrate suggesting CD. The patient currently remains asymptomatic with no new episodes of abdominal pain.
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References
1. Guerra I, Bujanda L, Mañosa M, et al; ENEIDA project of GETECCU. Clinical Presentation, Management, and Evolution of Lymphomas in Patients with Inflammatory Bowel Disease: An ENEIDA Registry Study. Cancers (Basel). 2023;15(3):750. doi: 10.3390/cancers15030750. PMID: 36765708; PMCID: PMC9913166.
2. Libicher M, Lamade W, Kasperk C, et al. Cicatricial small intestinal stenosis following chemotherapy for a gastrointestinal lymphoma. Dtsch Med Wochenschr. 1996;121(44):1359-62.
3. Kerr JP, Turner M, Ashton-Key M et al. Intestinal strictures: a new complication of treatment for primary gastrointestinal diffuse large B-cell lymphoma. Br J Haematol. 2008;140(6):712-714.
4. Gupta G, Agarwala S, Thulkar S, et al. Jejunal stricture: a rare complication of chemotherapy in pediatric gastrointestinal B-cell non-Hodgkin lymphoma. J Pediatr Hematol Oncol. 2011;33(2):e69-71.
5. Dias E, Andrade P, Cardoso H, et al. Primary small bowel follicular lymphoma: the role of balloon-assisted enteroscopy in diagnosis and follow-up. Rev Esp Enferm Dig. 2023 Jan;115(1):43-44.
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García Calonge M, Fernández Cadenas F, González Sánchez H, Muíño-Domínguez D, Morais Bras L, García Ramos M, et all. Intestinal stenosis developed after a complete response to chemotherapy in a patient with Crohn’s disease and lymphoma of the jejunum. 10004/2023


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Publication history

Received: 08/10/2023

Accepted: 11/10/2023

Online First: 26/10/2023

Published: 09/09/2024

Article Online First time: 18 days

Article editing time: 337 days


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