Non-Hodjkin's lymphoma of the appendix in children (clinical case)

Abstract

The distribution, morphological features, clinical presentation, diagnosis and treatment of a rare pathology in children - diffuse large B-cell lymphoma (DLBCL) of the appendix, which is a type of non-Hodgkin lymphoma of the appendix (NHL), are analyzed. NHL is a very rare neoplasm and accounts for about 0.015% of all lymphomas of the digestive tract. Only isolated cases of NHL in children have been described in the literature.

Aim - to study the prevalence, clinical features, diagnosis and treatment of DLBCL in children based on literature data and clinical observation.

A clinical case of this tumor in a 17-year-old adolescent is presented. The boy was admitted to the surgical department of the Ivano-Frankivsk Regional Children's Clinical Hospital in a moderately severe condition with complaints of abdominal pain, vomiting, fever up to 38°C and weakness. The onset of symptoms occurred 8 hours prior to admission. An objective examination revealed symptoms of acute appendicitis. An ultrasound examination of the abdominal organs revealed an increase in size and infiltration of the appendix. During the operation, an appendix with a tumor-like formation at the apex and enlarged mesenteric lymph nodes were found. A dense, immobile volumetric formation was also found in the retroperitoneal space on both sides of the spine. An appendectomy was performed en bloc with the tumor. One of the most altered lymph nodes and a fragment of the greater omentum were taken for biopsy. After the operation, a computed tomography scan of the abdominal cavity was performed. In the abdominal cavity, closer to the aortic bifurcation, a volumetric formation measuring 27×27×49 mm with a heterogeneous structure, was found. A spherical shadow measuring 26×33×24 mm was found caudal to the mass. Histological and immunohistochemical examination of the appendix and lymph node revealed characteristic changes of DLBCL. The postoperative course was without complications. The wound healed by primary tension. For further specialized treatment, the child was referred to the oncology center at their place of residence.

Conclusion. As evidenced by the presented clinical case, DLBCL of the appendix does not have specific clinical manifestations, manifesting itself with symptoms of acute appendicitis, the diagnosis is made on the basis of histopathological examination, and the disease may simultaneously affect other organs or lymph nodes.

The study was performed in accordance with the principles of the Declaration of Helsinki. Informed consent of the patient and his parents was obtained for the research.

The authors declare no conflict of interest.