A Case of Primary Non-Hodgkin's Lymphoma Presented as Appendicitis

ABSTRACT

Malignant lymphoma comprise 1~4% of the malignant neoplasms of the gastrointestinal tract (GIT), although primary lymphoma of the appendix is exceedingly rare. Primary non-Hodgkin's lymphoma (NHL) of the appendix reportedly represents 0.015% of all GIT lymphomas. Most cases of primary appendiceal lymphoma have presented with a clinical appearance of acute appendicitis. It is therefore difficult to diagnosis preoperatively. We report a case of primary NHL of the appendix in a 31 year-old female. Appendectomy was performed as a result of the clinical diagnosis of acute appendicitis, due to the rebound tenderness of McBurney's point and a thickend appendiceal wall seen on abdominal ultrasonography. Microscopic examination demonstrated an atypical large lymphoid cell dispersed in a background of small lymphocytes. There were no invading tumor cells on the resection margin. Immunohistochemical studies revealed the large atypical cells stained with B cell marker (CD20), Bcl-6, Ki-67 and UCHL-1 (CD45R0). The post-operative work- up consisted of a CT scan of the abdomen and thorax, a bone marrow biopsy and a gastrofiberscope. These results were normal. No further treatment was recommended. The patient is now 12 months post-operative and doing well.