Scientific letter
An infrequent cause of left-colon intussusception
Una causa infrecuente de intususcepción de colon izquierdo
Mathius Soruco García, Mariano Higa, Domingo Balderramo
Corresponding author
Gastroenterology Department, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
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Colo-colonic intussusception in descending colon (arrows). (B) Colonoscopy: pedunculated lesion located in the descending colon.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Mantle cell lymphoma (MCL) is a type of B-cell non-Hodgkin's lymphoma that is characterized by atypical small lymphoid cells within the mantle zone that surrounds normal germinal center follicles.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Represents 2.5% of lymphoid neoplasms in United States and 7–9% of lymphoid neoplasms in Europe.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> MCL is usually diagnosed in adults with a median age of 68 years with male predominance.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> The gastrointestinal tract is the most frequent secondary extranodal location, and colon is the most involved site.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Multiple lymphomatous polyposis is one of the most common primary gastrointestinal presentations of MCL.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Intussusception caused by malignant lymphoma is unusual, accounting for less than 10% of all cases of colonic intussusception.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Colonic involvement of gastrointestinal lymphomas is observed in 9–27%, although MCL represents only 1.2% of these lesions.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> We present the case of a patient with a diagnosis of MCL relapse manifested as left colo-colonic intussusception.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A 65-year-old man with a diagnosis of MCL 8 years ago treated with chemotherapy and autologous transplantation of hematopoietic precursors with good response and without evidence of recurrence in the later control (4 months before) presented with intermittent abdominal pain in the left lower quadrant without fever, weight loss, or diarrhea. On physical exam there were no significant findings. The blood count an biochemical study were within normal limits. Abdominal computed tomography (CT) identified a colo-colonic intussusception in descending colon associated with an endoluminal lesion that showed homogeneous enhancement (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). A colonoscopy was performed and identified a 50<span class="elsevierStyleHsp" style=""></span>mm pedunculated lesion in the descending colon (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). Biopsies of this lesion showed a lymphoproliferative infiltration (chromatin positive lymphocytes and positive immunostaining for CD20 and cyclin) in the lamina propria compatible to MCL. A multidisciplinary evaluation was carried out and treatment with oral ibrutinib 560<span class="elsevierStyleHsp" style=""></span>mg qd was started with initial good response. After 6 months of follow up, ibrutinib was finished and a new allogeneic transplantation of hematopoietic precursors was performed with good response after 3 months of follow-up.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The main proportion of patients with MCL relapse after combined therapy (chemotherapy and hematopoietic stem cell transplantation) have a median survival of 3–5 years.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> In the present case, MCL relapse was manifested as a single polypoid lesion of the descending colon causing colonic non-obstructive intermittent intussusception. Intussusception in adults is infrequent and represent less than 1% of bowel obstruction.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> In the colon, 60% of intussusception cases are related to malignancy.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> After reviewing the literature related to clinical manifestations of MCL, no case of left colonic intussusception was described as MCL presentation and few cases presenting ileocecal or right colo-colonic intussusception were described.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion, we present a case of left colo-colonic intussusception associated with MCL relapse. This presentation has not been previously reported. This case reinforces the importance of differential diagnosis of MCL recurrence in adult patients with history of MCL and left colon obstruction.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authors’ contribution</span><p id="par0030" class="elsevierStylePara elsevierViewall">Mathius Soruco García, Mariano Higa and Domingo Balderramo wrote the manuscript. All authors approved the submitted version.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Disclosures</span><p id="par0035" class="elsevierStylePara elsevierViewall">None of the authors have any potential conflicts (financial, professional, or personal) to disclosure.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">The present manuscript was performed without any financial support or grant.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Authors’ contribution" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Disclosures" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Funding" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 538 "Ancho" => 1005 "Tamanyo" => 83761 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Abdominal computed tomography. Colo-colonic intussusception in descending colon (arrows). (B) Colonoscopy: pedunculated lesion located in the descending colon.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mantle cell lymphoma with gastrointestinal involvement and the role of endoscopic examinations" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H.H. Lee" 1 => "S.G. Cho" 2 => "I.S. Lee" 3 => "H.J. Cho" 4 => "Y.W. Jeon" 5 => "O.J. Hyun" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "PLOS ONE" "fecha" => "2020" "volumen" => "15" "paginaInicial" => "e0239740" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case report of mantle cell lymphoma presenting as intussuscepting colon mass" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B.M. Smith" 1 => "K. Reilly" 2 => "B. Baker" 3 => "A. Deeken" 4 => "A.G. Dan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijscr.2020.03.022" "Revista" => array:6 [ "tituloSerie" => "Int J Surg Case Rep" "fecha" => "2020" "volumen" => "69" "paginaInicial" => "28" "paginaFinal" => "31" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32248013" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rare presentation of ileocolic intussusception secondary to mantle cell lymphoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "V. Aukhojee" 1 => "C.M. Gilong" 2 => "G. Seewoogoolam" 3 => "P.N. Strauss" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bcr-2019-229425" "Revista" => array:5 [ "tituloSerie" => "BMJ Case Rep" "fecha" => "2019" "volumen" => "12" "paginaInicial" => "e229425" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31420425" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lymphomas of the gastro-intestinal tract – pathophysiology, pathology, and differential diagnosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.M. Cardona" 1 => "A. Layne" 2 => "A.S. Lagoo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0377-4929.94847" "Revista" => array:6 [ "tituloSerie" => "Indian J Pathol Microbiol" "fecha" => "2012" "volumen" => "55" "paginaInicial" => "1" "paginaFinal" => "16" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22499293" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mantle cell lymphoma as a rare cause of intussusception: a report of 2 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Grin" 1 => "R. Chetty" 2 => "D. Bailey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.anndiagpath.2009.03.003" "Revista" => array:7 [ "tituloSerie" => "Ann Diagn Pathol" "fecha" => "2009" "volumen" => "13" "paginaInicial" => "398" "paginaFinal" => "401" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19917477" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1808869415300872" "estado" => "S300" "issn" => "18088694" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/02105705/0000004600000007/v1_202307121057/S0210570522002102/v1_202307121057/en/main.assets" "Apartado" => array:4 [ "identificador" => "9030" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Cartas científicas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/02105705/0000004600000007/v1_202307121057/S0210570522002102/v1_202307121057/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210570522002102?idApp=UINPBA00004N" ]
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