Clinicopathological characteristics and prognosis of patients with small bowel tumors: A single center analysis of 220 cases / 中华胃肠外科杂志

Objective: To analyze the clinicopathological characteristics and prognosis of patients with small bowel tumors. Methods: This was a retrospective, observational study. We collected clinicopathological data of patients with primary jejunal or ileal tumors who had undergone small bowel resection in the Department of Gastrointestinal Surgery, West China Hospital, Sichuan University between January 2012 and September 2017. The inclusion criteria included: (1) older than 18 years; (2) had undergone small bowel resection; (3) primary location at jejunum or ileum; (4) postoperative pathological examination confirmed malignancy or malignant potential; and (5) complete clinicopathological and follow-up data. Patients with a history of previous or other concomitant malignancies and those who had undergone exploratory laparotomy with biopsy but no resection were excluded. The clinicopathological characteristics and prognoses of included patients were analyzed. Results: The study cohort comprised 220 patients with small bowel tumors, 136 of which were classified as gastrointestinal stromal tumors (GISTs), 47 as adenocarcinomas, and 35 as lymphomas. The median follow-up for all patient was 81.0 months (75.9-86.1). GISTs frequently manifested as gastrointestinal bleeding (61.0%, 83/136) and abdominal pain (38.2%, 52/136). In the patients with GISTs, the rates of lymph node and distant metastasis were 0.7% (1/136) and 11.8% (16/136), respectively. The median follow-up time was 81.0 (75.9-86.1) months. The 3-year overall survival (OS) rate was 96.3%. Multivariate Cox regression-analysis results showed that distant metastasis was the only factor associated with OS of patients with GISTs (HR=23.639, 95% CI: 4.564-122.430, P<0.001). The main clinical manifestations of small bowel adenocarcinoma were abdominal pain (85.1%, 40/47), constipation/diarrhea (61.7%, 29/47), and weight loss (61.7%, 29/47). Rates of lymph node and distant metastasis in patients with small bowel adenocarcinoma were 53.2% (25/47) and 23.4% (11/47), respectively. The 3-year OS rate of patients with small bowel adenocarcinoma was 44.7%. Multivariate Cox regression-analysis results showed that distant metastasis (HR=4.018, 95%CI: 2.108-10.331, P<0.001) and adjuvant chemotherapy (HR=0.291, 95% CI: 0.140-0.609, P=0.001) were independently associated with OS of patients with small bowel adenocarcinoma. Small bowel lymphoma frequently manifested as abdominal pain (68.6%, 24/35) and constipation/diarrhea (31.4%, 11/35); 77.1% (27/35) of small bowel lymphomas were of B-cell origin. The 3-year OS rate of patients with small bowel lymphomas was 60.0%. T/NK cell lymphomas (HR= 6.598, 95% CI: 2.172-20.041, P<0.001) and adjuvant chemotherapy (HR=0.119, 95% CI: 0.015-0.925, P=0.042) were independently associated with OS of patients with small bowel lymphoma. Small bowel GISTs have a better prognosis than small intestinal adenocarcinomas (P<0.001) or lymphomas (P<0.001), and small bowel lymphomas have a better prognosis than small bowel adenocarcinomas (P=0.035). Conclusions: The clinical manifestations of small intestinal tumor are non-specific. Small bowel GISTs are relatively indolent and have a good prognosis, whereas adenocarcinomas and lymphomas (especially T/NK-cell lymphomas) are highly malignant and have a poor prognosis. Adjuvant chemotherapy would likely improve the prognosis of patients with small bowel adenocarcinomas or lymphomas.

Tumor miofibroblástico inflamatorio: presentación variable de una misma patología / Inflammatory myofibroblastic tumor: variable presentation of the same pathology

INTRODUCCIÓN: El tumor miofibroblástico inflamatorio (TMI) es una neoplasia benigna infrecuente, de comportamiento clínico impredecible. OBJETIVOS: describir 3 casos de TMI diagnosticados entre marzo 2014 y enero 2018 en Hospital Clinico San Borja Arriaran, y realizar una revisión actualizada de la literatura. CASO 1: Adolescente de género masculino de 14 años de edad, hospitalizado por dolor abdominal, diagnosticado de invaginación yeyunoyeyunal secundaria a un tumor de pared intestinal. La histología fue compatible con un tumor miofibroblástico inflamatorio. CASO 2: Adolescente de género femenino, edad 12 años, hospitalizada por neumonía y dolor lumbar en estudio asociado a pérdida de peso. Se diagnosticó una masa retroperitoneal que comprometía el músculo psoas derecho, músculos paravertebrales, vértebras, riñón derecho y diafragma ipsilateral. Se efectuó biopsia por punción cuyo resultado fue compatible con un tumor miofibroblástico inflamatorio. CASO 3: Preadolescente de género femenino de 11 años de edad, hospitalizada para estudio de infección del tracto urinario a repetición. Se identificó un tumor vesical y la biopsia mostró ser compatible con tumor miofibroblástico inflamatorio. CONCLUSIÓN: Debido al comportamiento variable del tumor miofibroblástico inflamatorio, el manejo de este dependerá de la localización, la expresión del anaplasic like lymphoma (ALK), el comportamiento del tumor y la posibilidad de resección.

INTRODUCTION: The inflammatory myofibroblastic tumor is an infrequent benign neoplasm with unpredictable cli nical behavior. OBJECTIVES: to describe three clinical cases at the San Borja Arriarán Clinical Hospital between March 2014 and January 2018 and to carry out an updated review of the literature. CASE 1: 14-year-old male adolescent, hospitalized due to abdominal pain, diagnosed with jejunojejunal intus susception secondary to an intestinal wall tumor. The histology was compatible with an inflamma tory myofibroblastic tumor. CASE 2: 12-year-old female adolescent, hospitalized due to pneumonia and low-back pain under study associated with weight loss. A retroperitoneal mass was diagnosed involving the right psoas muscle, paravertebral muscles, vertebrae, right kidney, and ipsilateral dia phragm. A puncture biopsy was performed and the result was compatible with an inflammatory myofibroblastic tumor. CASE 3: 11-year-old female pre-adolescent, hospitalized to study recurrent urinary tract infection. A bladder tumor was identified, and the biopsy showed compatibility with inflammatory myofibroblastic tumor. CONCLUSION: Due to the variable behavior of the inflammatory myofibroblastic tumor, its management will depend on the location, expression of the anaplastic lymphoma kinase (ALK), tumor behavior, and the resection possibility.

Enteroscopia asistida por balón simple en el manejo de la patología del intestino delgado: Experiencia de la Unidad de Intestino Delgado de la Clínica Anglo Americana durante el periodo de diciembre del 2012 a diciembre del 2018 / Single balloon enteroscopy in the management of small bowel pathology: Experience of the Small Bowel Unit - British American Hospital from December 2012 to December 2018

Objetivo: Describir la experiencia en el uso de la enteroscopia asistida por balón simple para el diagnóstico y manejo de la patología del intestino delgado en pacientes con anatomía normal y alterada por cirugía en la Clínica Anglo Americana. Material y método: El presente es un estudio descriptivo - retrospectivo que incluye a todos los pacientes que acudieron a la Unidad de Intestino Delgado de la Clínica Anglo Americana, para realizarse una enteroscopia asistida por balón durante el periodo comprendido entre diciembre del 2012 a diciembre del 2018. Resultados: Se realizaron 80 procedimientos de enteroscopia asistida por balón simple, 49 fueron realizados por via anterógrada y 31 por vía retrógrada. La edad promedio fue 60,78 años (20 a 88 años). 48 pacientes (60%) eran varones. El tiempo de inserción media fue 80 minutos para la vía anterógrada (55 - 141 minutos) y 110 minutos para la vía retrógrada (55 -180 minutos). La principal indicación para realizar la enteroscopia por balón simple fue hemorragia digestiva oscura, 45 casos (56,25%). Se realizaron 6 estudios de enteroscopias asistida por balón en pacientes con anatomía alterada (7,5%). Setenta de los ochenta procedimientos (87,5%) fueron realizados con sedación administrada por enfermería supervisada por gastroenterólogo en base a midazolam, petidina y propofol, no se presentó ninguna complicación respiratoria o hemodinámica. Los diagnósticos obtenidos más frecuentes por enteroscopia fueron: angiodisplasias de intestino delgado (20%), úlceras yeyuno ileales (17,5%) y neoplasias a nivel del intestino delgado (7,5%). La complicación que se presentó con más frecuencia posterior a la enteroscopia fue el íleo paralítico, 2 casos, y se asoció a no utilizar insuflación con dióxido de carbono durante el procedimiento. Conclusiones: La hemorragia digestiva oscura fue la principal indicación para realizar una enteroscopia asistida por balón simple. Los diagnósticos más frecuentes fueron angiodisplasias, úlceras yeyuno ileales y neoplasias a nivel del intestino delgado. La complicación más frecuente fue el íleo paralítico y se asoció a no utilizar insuflación con dióxido de carbono durante el procedimiento.

Objetive: To describe our experience with single balloon enteroscopy in the management of small bowel disease in British American Hospital, Lima - Perú. Material and methods: Descriptive and prospective study. We include all patients that come to perform a single balloon enteroscopy in small bowel unit of British American Hospital within December 2012 to December 2018. Results: We performed 80 procedures of single balloon enteroscopy, 49 were done by oral approach, 31 by rectal approach. Mean age were 60.78 years-old (20 - 88 years). 48 patients (60%) were male. The mean insertion time for oral approach was 80 minutes (55-141 minutes), and for rectal approach was 110 minutes (55-180 minutes). The main indication for single balloon enteroscopy was obscure gastrointestinal bleeding. 6 enteroscopies were performed in patients with altered surgical anatomy (7.5%). 70 of 80 procedures (87.5%) were performed with gastroenterology-administered sedation, using midazolam, pethidine and propofol, without any respiratory or hemodinamic complication. Diagnostics achieved by single balloon enteroscopy were small bowel angiodysplasias (20%), yeyuno ileal ulcers (17.5%) and small bowel neoplasia (7.5%). Paralytic ileus was the most common complication of single balloon enteroscopy, 2 cases, and both cases were associated after no using carbon dioxide insufflation during procedure. Conclusion: Obscure gastrointestinal bleeding was the main indication for single balloon enteroscopy. Diagnostics achieved by single balloon enteroscopy were small bowel angiodysplasias (20%), yeyuno ileal ulcers (17.5%) and small bowel neoplasia (7.5%). Paralytic ileus was the most common complication of single balloon enteroscopy, 2 cases, and both cases were associated after no using carbon dioxide insufflation during procedure

Primary Intestinal Lymphoma: A Clinicopathological Study.

Introduction: Primary intestinal lymphoma (PIL) is defined as an extranodal lymphoma arising in the intestine. This study includes 11 PILs. Objectives: The objective of this study was to evaluate the clinicopathological characteristics of primary non-Hodgkin's lymphoma (NHL) in the small and large intestine. All cases were reclassified according to the World Health Organization classification of lymphoma in 2001. Immunohistochemistry (IHC) was used to confirm the histopathological diagnosis. Materials and Methods: Eleven cases of primary non-Hodgkin in the small and large intestine were studied retrospectively in a 5 year period. There were seven cases of resected intestinal specimens and four biopsy specimens. Five cases from ileum and two cases each from caecum and duodenum and one case each from jejunum and duodenum. Hematoxylin and eosin stained sections were studied with light microscopy and IHC for CD5, 20, 21 and cyclin D1 were done. Results: It is a retrospective study of 11 cases of intestinal lymphomas. Abdominal pain and abdominal lump were two main common presenting symptoms. NHLs were more common in the small intestine. PILs are common in adults (75% above 46 years) with male preponderance. All were NHLs and B-cell type. Five cases were diffuse large B-cell lymphoma and four cases each were mucosa-associated lymphatic tissue lymphoma and follicular lymphoma. One case was lymphomatoid polyposis or mantle cell lymphoma. Conclusion: PILs is rare and differs significantly from their gastric counterpart, not only in pathology but also with regard to clinical features, management and prognosis. Due to the lack of characteristic symptoms and a low incidence rate, PIL is misdiagnosed until serious complications occur, such as perforation and bleeding and hence needs to be accurately diagnosed.

Enteroscopía como método diagnóstico para neoplasias de intestino delgado / Enteroscopy as a diagnostic method for neoplasms of small intestine

Las neoplasias del tubo digestivo constituyen un verdadero reto para el médico. Hasta hace unos años el estudio de la patología del intestino delgado se realizaba a través de métodos no invasivos de visión indirecta (tránsito intestinal, tomografía computarizada axial, resonancia magnética nuclear o gammagrafía) o métodos invasivos de visión directa que exploraban la totalidad de intestino delgado a través de cirugías abdominales (enteroscopía intraoperatoria). Con el inicio de la enteroscopía por pulsión los tumores benignos o malignos localizados entre la 2° porción del duodeno y la válvula ileocecal, han dejado de ser diagnósticos apegados a procedimientos con baja sensibilidad o una elevada tasa de complicaciones. La facilidad con la cual la enteroscopía puede realizar un diagnóstico histopatológico a través de la toma de muestras o la realización de un tratamiento terapéutico lo vuelven una herramienta útil para el médico y la búsqueda de tumores del intestino delgado. El presente caso corresponde a un paciente masculino, de 64 años, conocido por una enfermedad diverticular, quien presenta síntomas constitucionales que hacen sospechar una neoplasia del tracto digestivo; se realiza una endoscopia de tubo digestivo superior la cual es normal, luego una Tomografía Axial Computarizada Abdominal que muestra una lesión a nivel de la 4° porción del duodeno en la que no puede establecerse su origen intra o extra-luminal, hasta que se realiza una enteroscopía como un método diagnóstico.

Metastatic Recurrence of Small Bowel Cancer in Crohn's Disease / 대한소화기학회지

No abstract available.

Neoplasias del intestino delgado / Small intestinal neoplasms

Small intestine tumors are infrequent lesions during the routine clinical practice. They appear sporadically, in association with genetic diseases (e.g familiar adenomatous polyposis or Peutz-Jeghers syndrome), or associated to chronic inflammatory diseases (e.g Crohn’s disease or celiac disease). Benign tumors of small intestine (e.g leiomyomas, lipomas, adenomas, hamartomas or desmoid tumors) are generally asymptomatic, and may show up with intussusception. Primary malignant small intestine tumors (e.g adenocarcinoma, leiomyosarcoma, carcinoid tumor and lymphoma), can appear with intestinal obstruction, jaundice, digestive bleeding or abdominal pain. Small intestine metastatic lesions can appear by nearness, peritoneal metastasis or by hematological way. This last dissemination type is infrequent and more typically of melanoma. Because of its low prevalence, unspecific symptomatology and relative inaccessibility by conventional endoscopy, the diagnostic of small intestine neoplasm is often made several months after the first symptoms. Enteroclysis is a useful imaging technique towards the small intestine neoplasm suspicion. The endoscopic capsule and enteroscopy are actually the best diagnostic and therapeutic methods for this type of neoplasm. The treatment depends in the type of neoplasm, being the tumoral resection the first-line therapy.

Los tumores de intestino delgado son lesiones infrecuentes en la práctica clínica habitual. Aparecen de forma esporádica en asociación con enfermedades genéticas (por ej., poliposis adenomatosa familiar o síndrome de Peutz-Jeghers), o bien asociados a enfermedades inflamatoria crónicas intestinales (por ej., enfermedad de Crohn o enfermedad celíaca). Los tumores benignos de intestino delgado (por ej., leiomiomas, lipomas, adenoma, hamartoma o tumor desmoide) son generalmente asintomáticos, pudiendomanifestarse con intususcepción. Los tumores malignos primarios de intestino delgado (por ej.,adenocarcinoma, leiomiosarcoma, carcinoide y linfoma), pueden presentarse con obstrucción intestinal, ictericia, sangramiento digestivo o dolor abdominal. Las lesiones metastásicas de intestino delgado pueden aparecer por contigüidad, metástasis peritoneal o por vía hematógena. Este último tipo de diseminación es infrecuente y más típico del melanoma. Debido a su baja prevalencia, sintomatología inespecífica y relativa inaccesibilidad por endoscopía convencional, el diagnóstico de las neoplasias de intestino delgado es realizado a menudo varios meses después de iniciado los síntomas. La enteroclisis es una técnica de imagen útil frente a la sospecha de neoplasia de intestino delgado. La cápsula endoscópica y la enteroscopía son los métodos actualmente de mayor rendimiento para el diagnóstico y eventual terapia de este tipo de neoplasias. El tratamiento depende del tipo de neoplasia, siendo la resección tumoral la terapia de primera línea.

In situ follicular neoplasia/lymphoma: Three illustrative cases exemplifying unique disease presentations.

We report three elderly patients with follicular lymphoma in situ (FLIS) each highlighting a unique pattern of disease presentation and progression. The first patient had incidentally detected FLIS with peripheral blood spill and yet had an 11-year uneventful follow up. The second patient with an overt follicular lymphoma (FL) developed high-grade transformation in jejunum with FLIS extensively involving the Payers patches. The third patient had a FLIS but that qualified as higher grade and was treated in spite of lack of overt FL mainly because of higher grade and patient subsequently did develop overt FL. The first case of typical FLIS confirms that peripheral blood spill does not connote poor prognosis in FLIS, the second case illustrates that FLIS may colonize mucosa-associated lymphoid tissue as part of homing in process of a disseminated FL and the third case validates the aggressive nature of high-grade FLIS.

Malformación linfangiomatosa intestinal con tejido pancreático ectópico: a propósito de un caso y revisión de la literatura / Intestinal lymphangiomatosis with ectopic pancreatic tissue: a case report and literature review

Intestinal lymphangiomatosis is a rare malformation typically affecting children. Its etiology is unknown, although several hypotheses have been proposed. We present a case of intestinal lymphangiomatosis with ectopic pancreatic tissue of the mesentery, an association not previously described in literature. We emphasize the fact that this entity has sometimes been associated with other intra-abdominal malformations, even conditions undescribed in scientific literature. It must be considered the first differential diagnosis for pediatric patients with radiological evidence of mesenteric cystic lesions, subsequently confirmed by pathological examination.

La malformación linfangiomatosa intestinal es una entidad poco frecuente, típica de la edad pediátrica, cuya etiopatogenia es desconocida, aunque se barajan varias hipótesis. Presentamos un caso de linfangiomatosis intestinal con tejido pancreático ectópico mesentérico, una asociación no descrita anteriormente en la literatura. Destacamos la importancia de conocer que esta entidad, en ocasiones, se asocia a otro tipo de malformaciones intrabdominales, incluso no descritas previamente en la literatura. Se debe plantear como el primer diagnóstico diferencial durante la edad pediátrica, ante el hallazgo radiológico de lesiones quísticas mesentéricas, confirmando posteriormente mediante un estudio anatomopatológico de las lesiones.

Incidental Gastrointestinal Subepithelial Mass / 대한소화기학회지

Incidental gastrointestinal subepithelial mass is increasing with national cancer screening endoscopy. Most of gastrointestinal subepithelial mass are small-sized and asymptomatic tumor with benign nature, but gastrointestinal stromal tumor should be ruled-out because of its malignant behavior. Although conventional endoscopy alone can differentiate the nature of subepithelial mass, more accurate diagnosis can be achieved with endoscopic ultrasonography and its guided biopsy. In this review, differential diagnosis and treatment strategy of incidental gastrointestinal subepithelial mass would be presented.

Avaliação da resposta inflamatória sistêmica como marcador de atividade tumoral em pacientes com câncer colorretal / Evaluation of systemic inflammatory response as a marker of tumor activity in patients with colorectal cancer

Introdução: Marcadores biológicos têm sido estudados com objetivo de identifi car fatores que possam predizer a evolução dos pacientes com câncer colorretal e ajudar a selecionar os grupos com alto risco de recidiva; porém os estudos existentes são insufi cientes para serem recomendados na rotina de atendimento clínico. Desse modo, a realização de estudos clínicos procurando correlacionar a evolução do paciente com possíveis marcadores de atividade tumoral estão sendo realizados com o objetivo de contribuir para a formação de bases científi cas sólidas, capazes de modifi car as ferramentas de avaliação clínico-laboratorial. Objetivo: Verifi car a correlação da resposta infl amatória sistêmica com a evolução clínica do câncer colorretal em pacientes sob acompanhamento clínico-laboratorial. Métodos: Foi realizado um estudo observacional do tipo descritivo para avaliação de marcadores de atividade infl amatória em pacientes portadores de adenocarcinoma colorretal. Foram coletadas amostras de sangue no pós-operatório para a dosagem dos níveis séricos de proteína C-reativa (PCR) e interleucina-10 (IL-10). Os níveis séricos dos pacientes foram analisados de acordo com dois grupos de pacientes: ressecção curativa e não curativa. A atividade tumoral foi avaliada pela análise dos níveis séricos de antígeno carcinoembrionário (CEA) em todos os pacientes do estudo. Resultados: Os níveis da PCR e do CEA no grupo de ressecção curativa foi signifi cativamente menor em relação ao grupo de ressecção não curativa (p<0,05). Em relação aos níveis de IL-10, não foi observada uma diferença signifi cativa entre os grupos (p >0,05). Conclusões: Os resultados sugerem que os níveis séricos de PCR, marcadores de atividade infl amatória inespecífi ca, refl etem indiretamente a atividade tumoral. Entretanto, outros estudos com uma amostra maior de pacientes são necessários para investigarmos esta possível correlação dos níveis séricos de PCR com a evolução clínica do câncer colorretal.

Introduction: biological markers have been studied in order to identify factors that would be able to predict evolution of patients with colorectal cancer that could help to select high risk relapse groups. However, none of them has been recommended for clinical use. Objective: verify the correlation between the systemic infl ammatory response and tumor activity in patients with colorectal carcinoma. Methods: An observational and descriptive study was performed. Blood samples from 28 patients were collected postoperatively for determination of C-reactive protein (CRP) and Interleukin-10 (IL-10). Th e analysis was performed comparatively according to curative and non curative resection. Th e tumoral activity was investigated using the evaluation of carcinoembryonic antigen (CEA) serum leves in all patients studied. Results: the correlation levels of CPR and CEA in the curative resection group was lower compared with non curative resection group (p< 0.05). No diff erence between the groups was observed in the levels of IL-10. Conclusions: Th is study suggests that high levels of CRP, an inespecifi c infl ammatory biomarker, correlated with the evolution of colorectal carcinoma. However, others studies may be perform to investigate this hypothesis.

Small bowel tumors: insidious and important abdominal problems for surgeons

To evaluate the major clinical symptoms, etiology and presentation of small bowel tumors so that they can be diagnosed. Retrospective study. Izmir Bozyaka Teaching and Research Hospital, Turkey. Forty-five patients with 46 small bowel tumors over a 15-year period were included in the study. Biopsy or small bowel resection. The data obtained from the medical records including clinical features, diagnostic workup, operative procedures and pathologic diagnosis. The male to female ratio was 1.4:1 with a median age at presentation of 53 years [range, 30 - 83 years]. Thirty [66.7%] patients presented with abdominal emergencies such as bowel obstruction [40%], bowel perforation [24.4%] and intestinal bleeding [2.3%]. Non-urgent presentations were found in 15 [33.3%] patients. The preoperative diagnosis of small bowel tumor was positive in nine [20%] of the elective cases. The tumors were located in the ileum in 68.8%, the jejunum in 26% and the duodenum in 6.6% of patients. Thirty-eight [82.6%] malignant and eight [17.4%] benign tumors were identified. In addition, patients with malignant tumors more commonly presented with bowel obstruction and perforation. Segmental resection was done in 41[91%] patients. These observations suggest that small bowel tumors are difficult to diagnose because of delayed presentations and vague symptoms. Clinicians must have a high degree of suspicion and should perform early laparotomy without hesitation

Small intestinal tumours

Small bowel neoplasms continue to be an enigma to the clinicians. The insidious onset, the subtlety of the signs, the lack of definitive pre-operative diagnostic tests with often variable efficacies makes them difficult to diagnose. Small bowel consciousness is crucial in diagnosing and treating these tumours. This review aims to increase awareness of small bowel tumours in terms of epidemiology, diagnosis and treatment

Cystic lymphangioma of the small intestine in a young girl

We describe a case of a 12-year old girl who presented with abdominal pain. A large abdominal mass was discovered on physical examination. Preoperative studies including abdominal ultrasonography and CT scan were performed, but they could not accurately determine the nature of the tumor. At laparotomy, a large cystic tumor of the small bowel was found. Histopathologic examination revealed a tumor of cystic lymphangioma. Although lymphangiomas are rare, especially in the abdomen, they may sometimes present as abdominal pain and acute abdomen, causing complications that require emergent surgery

Primary marginal zone B-cell lymphoma of appendix.

Primary lymphomas of appendix are extremely rare tumors. The first case of primary lymphoma of appendix was reported by Warren in the year 1898. Incidence of primary lymphoma of appendix is 0.015% of all gastrointestinal lymphomas. This is a report of primary marginal zone B-cell lymphoma of appendix which presented as appendicular mass. As some cases are incidentally discovered, this case emphasizes that histological examination of all appendicectomy specimens is mandatory.