A rare presentation of a 17-year-old female with primary colon lymphoma, presenting as intussusception: a case report

Abstract

Introduction and importance: Primary colonic lymphomas are rare malignancies that mainly occur in men in their fifth to seventh decades, accounting for less than 1% of colorectal cancers. Most are B-cell non-Hodgkin lymphomas, with diffuse large B-cell lymphoma (DLBCL) being the most common subtype. Diagnosis is often challenging due to nonspecific symptoms, and management typically relies on systemic immunochemotherapy. Surgery retains a vital role in selected cases, particularly those with complications or localized disease. We present an interesting case of a 17-year-old girl with primary colonic DLBCL presenting with intussusception, who was treated at Ocean Road Cancer Institute in Tanzania. Case presentation: A 17-year-old female of African origin experienced chronic abdominal pain and a loss of appetite for 6 months. An ileocolic intussusception was diagnosed through a CT scan and intraoperative findings, and a right hemicolectomy was performed. Histopathological examination of the resected specimen revealed DLBCL of the colon, with immunohistochemistry positive for CD20 and CD45, confirming a diagnosis of primary colorectal lymphoma. Later, the patient received systemic chemotherapy with R-CHOP for eight cycles. She is clinically stable and has been under follow-up for the past year. Conclusion: Primary colonic DLBCL in adolescents is exceedingly rare. This case presents unique features such as chronic abdominal pain and anorexia, which can lead to misdiagnosis due to a broad differential. There is a need to provide knowledge of primary colon lymphoma to ensure early diagnosis and favorable outcomes.